## Credits and acknowledgements

TWIXTlab is a non-profit organisation from Athens, Greece, active in the fields of contemporary art, anthropology and everyday life. Our fields of action include art-and-humanities lifelong education, research and artistic creation. During the COVID pandemic, we sought to take our actions into tel-ecommunication media, introducing our experimental twixtlab-radio. TWIXTlab was established in 2014 and is currently run by founding members Elpida Rikou and Sophia Grigoriadou, with the addition of Eugenia Vacalopoulou and Yorgos Samantas. The latter contributed to the project as a manager, general coordinator, researcher, and in some cases as an executive manager.

TWIXTlab's contribution in the B-AIR project wouldn't have been made possible without the invaluable guidance of our scientific advisor for the project, anthropologist and prolific writer Panayotis Panopoulos (University of the Aegean). Our community liaison, visual artist and curator Ourania Anastasiadou (Head of the Accessibility Department of the Athens School of Fine Arts), provided us with key insights for the Deaf community in Greece, and the worldwide scene of Deaf arts. Our educational coordinator, musicologist, sound artist and pedagogue Dana Papachristou overtook the key task to develop our educational methodology and coordinate the school work.

Our art education activities would be poor if they would not have been welcomed with the enthusiasm of our invited artists: Tatiana Remoundou, Lambros Pigounis, Kalliopi Takaki, Petros Flambouris, Giorgos Mizithras and Orestis Karamanlis were constantly providing us with rich input, while negotiating their ways with sound and music with our students-participants.

Further, we would like to thank the educational staff and management of the Argyroupolis High School for the Deaf and Hard of Hearing, who welcomed us in their school setting and facilitated a flawless collaboration with them. We would not have achieved any depth without the essential help, input and mediation by English teacher and SL interpreter, Xenia Nikolakopoulou. Along with them, the invitation from the Educational Department of the National Opera of Greece provided us with the opportunity to enrich our approaches and address them to young adult participants.

Parallel to the workshops, we further pursued best practices exchange and learning from international interlocutors, who were also engaged with approaches on Deaf accessibility and inclusivity in the arts. Eva Fotiadi from CARADT, Amsterdam, co-curator of the Dutch initiative "Other Abilities" by Adie Hollander, and David Bobier from "VitraFusionLab" in Canada, Leslie Putnam, with her affectionate display of her sound-vibrational sculptures, and Nicole Watson from Surface Area Dance Theatre for her approaches and practice on wearable technologies for Deaf inclusivity in dance, all offered invaluable knowledge, advice and thoughtfulness towards the endeavour.

In addition to the fields directly related to Deaf arts and culture, we would additionally like to thank our academic network, within whose frameworks we had the opportunity to discuss our theoretical concepts, methodological approaches, and outcomes. Our partners in B-AIR created sharing opportunities with local and international networks of experts, like the CRESSON's 9th and 10th Winterschools, B-Air Days at Cuneo Conservatory, 'How does the world sound' in Cerisy Colloque as 'a castle of crossed disciplines', and the invitation to a "Ball Theatre" in the French Pavilion of the 18th Biennale of Architecture in Venice, and BAZAART's "Centers and Margins - Forces of rapprochement" conference in Belgrade, and Sound and Music in the Lived Experience of Infants, Babies and Vulnerable Groups Symposium in Ljubljana organised, among others, by RTV Slovenia. Further extending the direct network of B-Air, MUTE project's lead investigator Anna Papaeti and the research team, prolific writer and sound theorist Brandon LaBell from the Listening Biennale and the 'Listening as Witnessing' Symposium, and Arjang Omrani's 'Multimodal Storytelling' from University of Gent, provided us with new insights related to our approaches, and a safe ground for developing, discussing and reflecting upon our practice.

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SONIC
REMEMBERING

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# SONIC REMEMBERING: RECREATION OF LIFE

Part of the activities of the B-AIR project focused on sonic memories, by paying special attention to the acts of remembering, and to the ways in which sonic memories are narrated. In our work we have paid special attention to the cultural, social, and aesthetic nature of sounds, aiming to raise awareness of polyphonic histories and values, thus enhancing the understanding of the Europe's acoustic heritage.

One of the important objectives of the activities has been the promotion of agency, and social inclusion of the vulnerable groups, including the oldest radio listeners in Europe – groups in the ‘third’ and the ‘fourth age’, and people who have experienced war traumas. In the following sub-chapters of this publication, we are listening to processes and makings of both the “Evenings of Sounds” broadcasted via three national radios in Europe – in Finland, Serbia, and Slovenia – and the joint venture of making the ““European Evenings of Sounds””. Thereafter, the Bosnian B-AIR sub-project on sonic war memories is discussed.

## Sonic remembering as a dynamic process

When defining concepts such as social, collective, and cultural memory (Järviluoma, 2009a, 2020; see also Assman, 2008), it seems obvious that social

memory stands out as the comprehensive concept. This is especially the case if it is defined as consisting of memories shared by a group – or at least memories that are jointly agreed upon. Even personal memory often has a shared framework (Boym, 2001; Misztal, 2003). The past is always mediated and produced through memory work, and it is through the acts of remembering that we present ourselves to ourselves and to others (Misztal, 2003; Järviluoma, 2009a, 2009b, and 2020).

Therefore, the term ‘social remembering’ is an even more advantageous concept than social memory. Indeed, it grasps the dynamic nature of the phenomenon much better. The first sociological theories of collective memory constructed social and group memories as static and have therefore been subject to considerable criticism (Misztal, 2003). Such theories fail to capture the dynamism and transience of our media-saturated contemporary culture, the time lived and forgotten, the clashes between different social and ethnic groups and the ever-fragmenting politics of memory (Huyssen, 2003).

Memories, including sonic memories, do not remain the same all the time, they live: new elements are added to them over time in the processes of understanding (cf. Mistztal, 2003). What makes these active processes of remembering particularly

interesting is that the past and the ways in which it is remembered are influenced both by the state of mind of the rememberer, and by the situation in which he or she is currently remembering (Schacter, 2001; Järviluoma, 2009b, 2020). Chaudhury and Rowles (2005) have analysed ageing, place and remembering, and found that when an individual remembers, they recreate the original experience using both memory and imagination (p. 11). This re-creation is influenced by the physical, psychological, and social changes that have occurred to the individual over a lifetime. For example, older people's experiences may take on new meanings, as a result of retirement, physical frailty, or environmental change (ibid. pp. 11–12).

It takes sophisticated concepts and methods, as well as a great deal of imagination to evoke and explore sonic memories. The production of memories through the processes of personal and communal storytelling has provided us with a lot of very interesting things to reflect on and analyse in the B-AIR data.

<figure><img src="image_394.png" /></figure>
<figure><img src="image_395.png" /><figcaption>Organist Esko Juntti, age 92, being interviewed by Helmi Järviluoma, October 2022. Esko remembered his days in woods with cows, and forest soundscapes, as a shepherd boy in 1930s in Oulunsalo, Finland. Photo by Jouko Varjos</figcaption></figure>

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UNIVERSITY
OF EASTERN
FINLAND

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RADIO
TELEVIZIJA
SLOVENIJA

PTC

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EUROPEAN
EVENING OF
SOUNDS
# EUROPEAN EVENINGS OF SOUNDS

"European Evenings of Sounds" is founded on a series of radio programmes "Evening of sounds" (Äänien ilta) broadcasted by the Yleisradio - Finnish Broadcasting Company. It was initiated in the year 2012 by the radio host Jukka Mikkola and two soundscape scholars and professors, Helmi Järviluoma and Heikki Uimonen.

The idea for the programme was to construct new content for contemporary radio by introducing environmental sounds and related narratives and discussions. It instantly became evident that sounds and soundscapes were eliciting emotions and recollection and that radio listeners were willing to share their memories and experiences with their fellow listeners. A three-hour call-in live show had approximately 220 000 listeners, representing 3,7 percent of the country's population of 5,4 million (Uimonen 2019).

The "Evening of sounds" radio programme stemmed partly from the pedagogic goals of early soundscape researchers in the attempt to make radio audience to listen to their environment attentively. At the same time the programme popularised scholarly research and developed dialogue with the audience. The feedback has evoked new research tasks and research questions among the scholars. Live shows also raised questions – if public service radio should be responsible for taking care of the sonic cultural heritage by

preserving, creating and maintaining it in the context of contemporary transforming soundscape, and which would be the means for these actions (Uimonen 2019).

With the radio programme "European Evenings of Sounds", within the B-AIR project, we strove for making our philosophy and radio practices transnational, through collaboration with Finnish Broadcasting Company and the broadcasters RTS in Serbia and RTV Slovenia. By creating a collaborative link between the intangible sonic heritages of the continent, the aim was to increase understanding and awareness of both the common European intangible heritage and the specific characteristics of its diverse acoustic heritage.

"European Evenings of Sounds" focused on sound memories by paying special attention to the acts of remembering and the ways the sound memories were narrated. It targeted to further develop the concept and practices of the electro-acoustic community, which was constructed during the live broadcast by the studio hosts and the audiences. The programme paid particular attention to the cultural, social and aesthetic nature of the sound requests of the callers, considering them to be parallel to those of music call-ins in sharing music and experiences related to them.

Within the general aim of raising awareness of the Europe's common history and values by enhancing the understanding of its acoustic heritage, the objective of promoting the agency and social inclusion of the oldest listeners appeared as particularly important. In preparation of the "European Evenings of Sounds", in order to collect material for the research of sonic remembering and for the programme, the Finnish team visited three care homes and interviewed elderly citizens on their sound-related memories. What they have found was strongly in line with the project focus. Namely, while reaching the 'fourth age' has sometimes been considered to mean solely that an old person has become frail and dependent, we subscribe to the idea that this does not necessarily mean that she or he has no agency in society (Grenier 2012). In the end, the programme contributes to social inclusion and agency of exactly the population living in this stage of their life course.

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## Literature

Assmann, J. (2008). Communicative and cultural memory. In A. Erll & A. Nünning (Eds.), *Cultural memory studies: An international and interdisciplinary handbook* (pp. 109–118). Walter de Gruyter.

Boym, S. (2001). *The Future of Nostalgia*. The Basic Books.

Grenier, A. (2012). *Transitions and the Lifecourse: Challenging the Constructions of ‘Growing Old’. Policy Press.*

Chaudhury, H., & Rowles, G. D. (2005). Between the shores of recollection and imagination: Self, aging, and home. In G. D. Rowles & H. Chaudhury (Eds.), *Home and identity in late life: International perspectives* (pp. 3–20). Springer.

Huyssen, A. (2003). *Present pasts: Urban palimpsests and the politics of memory*. Stanford University Press.

Järviluoma, H. (2020.) “Dis-placement,” Aging and Remembering: Case Study of a Transnational Family. In L. Grenier & F. Valois-Nadeu (Eds.), *A Senior Moment. Cultural Mediations of Memory and Aging* (pp. 165–194). Transcript publishing.

Järviluoma, H. (2009a). Soundscapes and Social Memory in Skruv. In H. Järviluoma, B. Truax, H. Uimonen, N. Vikman & M. Kytö (Eds.), *Acoustic Environments in Change* (pp. 138–153). TAMK publications.

Järviluoma, H. (2009b). Scythe-drive Nostalgia and Agricultural Ambiences in Bissingen. In H. Järviluoma, B. Truax, H. Uimonen, N. Vikman & M. Kytö (Eds.), *Acoustic Environments in Change* (pp. 154–171). TAMK publications.

<figure><img src="image_401.png" /><figcaption>Sound workshop in Peurankallio care home led by Heikki Uimonen and Helmi Järviluoma, April 2023
Photo by Helmi Järviluoma</figcaption></figure>

Misztal, B. (2003). *Theories of social remembering*. Open University Press.

Schacter, D. L. (2001). *Muisti. Aivot, mieli ja menneisyys*. [Searching for Memory: The Brain, the Mind, and the Past]. Terra Cognita.

Uimonen, H. (2019). Evening of Sounds: Auditory Cultures in Radio Call-in Programmes. In M. Droumeva & R. Jordan (Eds.), *Sound, Media, Ecology* (pp. 261–284). Palgrave MacMillan.

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# FINLAND: EUROPEAN EVENING OF SOUNDS
## Production of the Finnish Broadcasting Company (YLE)

What kind of meanings and memories do sounds and soundscapes carry with them? How do different countries and cultures sound like? What kind of sounds do different countries offer to European radio listeners? Do different countries have some unique sounds that others have never heard and don't know of? Are there some undoubtedly common sounds and soundscapes, some shared sound-related meanings that are known all around?

We had to think about those questions when we started planning the broadcast of the “European Evenings of Sounds” – a special live radio show that would bring together voices, sounds and soundscapes of three countries: Serbia, Slovenia and Finland. The broadcast was done in cooperation of the three national broadcasting companies: RTS Serbia, RTV Slovenia and YLE Finland.

The “European Evenings of Sounds” was broadcasted on Monday 29th May 2023 at 16.05 - 17.20 UTC, simultaneously on three different channels, from three different cities: Belgrade, Ljubljana and Helsinki. The broadcast was divided into three 15-minute episodes, as follows:

* 16.05 – 16.20 UTC, on air: Serbia, Slovenia, Finland
* 16.25 – 16.40 UTC, on air: Serbia and Slovenia
* 16.45 – 17.00 UTC, on air: Serbia and Finland
* 17.05 – 17.20 UTC, on air: Slovenia and Finland

In the RTS studio in Belgrade the host was Nikoleta Dojčinović. In the RTV Slovenia studio in Ljubljana the hosts were Anamarija Štukelj Cusma with her radio colleagues Mojca Delač and Maj Valerij. In the YLE studio in Helsinki the hosts were Jukka Mikkola with professor emerita of Cultural Studies Helmi Järviluoma and professor of Cultural Studies Heikki Uimonen.

The “Evening of Sounds” broadcasts previously made in Finland since 2012, have brought out sounds from the past as well as the present: from a cabinet clock to an effervescent tablet, from a pack of wolves to roaring frogs, from a steam engine to an old time car, and from a planer to a dental drill.

With the idea of the “European Evenings of Sounds” we wanted to explore how does it sound when voices from further afield, from a wider area, both geographically and culturally, come along? On a practical level, this all was done by partners broadcasting sounds to each other, discussing and reflecting on cultural meanings of sounds and soundscapes, and popularizing scientific knowledge about sounds and the study of soundscapes. The countries participating in the broadcast were sending each other sounds and telling stories about the soundscapes of each country and culture.

<figure><img src="image_403.png" /><figcaption>Jukka Mikkola at the B-AIR Days in Cuneo, Italy, October 2022. Photo by Helmi Järviluoma</figcaption></figure>

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The sounds, soundscapes and sound postcards heard during the "European Evenings of Sounds" broadcast were for example:

* Snow dropped from the roof with a snow pusher (from Finland)

* Wood stove, roasting peppers for 'ayvar' (from Serbia)

* Sharpening a scythe (from Slovenia)

* Carpet washing by hand with a brush on the Helsinki seashore (Finland)

* Belgrade bus station soundscape, recorded in the early 1970's (Serbia)

* Jackals of Bela Krajina howling (Slovenia)

* Extracting water from the well in the village of Jelovik (Serbia)

* Sound of the mining trolley in Slovenian mine Mežica (Slovenia)

* Gaming with an old slot game machine "Pajatso" (Finland)

* Ukrainian war refugee telling about her experiences of being clinically dead (Finland)

* A soundwalk recorded at the EXIT music festival in the Petrovaradin Fortress (Serbia)

* Reindeer round-up in Northern Finland, the Saami-area (Finland)

* A Thai women, settled into Finland, listening and singing music from her home country while using a sewing machine (Finland)

* Dripping water in Postojna stalactite cave (Slovenia)

The basic idea of the "European Evenings of Sounds" was to play emotional and conversational, varied and interesting sounds to the listeners, and thus to draw attention to everyday sounds as well as to the already lost sound environments. The aim was also to highlight the radio basic material, which is sounds, and trust in what is the most characteristic and historically essential thing about radio: how the sounds create imagery, speech, stories and conversation.

Of course, problems and setbacks arose when such a joint broadcast by three countries and three radio stations was planned. One question rose above the others: what language will be spoken in the broadcast? Even though English was the only common language for all the participants, it was decided that we will not broadcast in English, but on the contrary, we want to highlight the participants' own languages: Serbian, Slovenian and Finnish. Our shared view was that languages carry culture with them, and besides, it could be fun to hear three different languages on the broadcast, despite the fact that the participants of the broadcast do not understand each other's languages.

But how to carry out a live radio broadcast without a common language? The solution was found in precise advance planning and a joint script. The working language of the script, which was prepared jointly online, was of course English, but the actual parts of the broadcast were spoken by each host in their own language. The idea that seemed confusing at first turned out to be a very functional, vibrant and interesting sounding option.

The condition for the flexible progress of the broadcast was that each of the hosts knew what the others were saying and could participate in the conversation in their own language. This required

close monitoring of both the script and the broadcast, but it worked. The hosts of the broadcast held numerous rehearsals online in advance, during which the script was specified and the rhythm of the broadcast was considered.

Yet another concern was the real-time connection between the radio studios. How would the simultaneous radio broadcast of studios located in three different countries work out? In this regard, the worry was pointless, because with modern technology, it is easy to build a simultaneous network-based radio connection, especially when all the countries participating in the broadcast were members of the European Broadcasting Union (EBU). So the hosts didn't have to worry about the technology during the broadcast.

To read about the "European Evenings of Sounds":

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To listen to the programme, see podcast "European Evenings of sounds", with Štukelj Cusma, Rakef, Delač and Valerij as hosts, produced on May 29th 2023:

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<figure><img src="image_408.png" /><figcaption>Workshop for the "European Evening of Sounds", Ljubljana, Slovenia, May 2022. Photo by Helmi Järviluoma</figcaption></figure>

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# SERBIA: EUROPEAN EVENING OF SOUNDS
## Production of the Radio Belgrade 1, RTS

One of the main objectives of the Creative Europe program is “to preserve, develop and promote Europe’s cultural and linguistic diversity and heritage, and to increase the competitiveness and economic potential of the cultural and creative sector” (Creative Europe, 2014–2020).

It is safe to say that the programs supported through Creative Europe are part of cultural diplomacy and its 'soft power'. Over time, cultural diplomacy has gained a wider meaning in terms of mutual understanding between nations and their peoples, and through the exchange of information, ideas, art and other forms of culture. Also, as David Clarke reminds us, “besides art in the narrower sense, ‘cultural’ in cultural diplomacy also includes radio and television, exchange programs and language education” (2020, n. p.).

And actually, is language an obstacle in the production of international radio shows? And how to promote language diversity through radio broadcasts?

Unlike television, where subtitling of content is possible, and thus auditory accessibility to linguistic diversity, for radio as a medium, foreign languages are essentially a barrier.

Radio and Television of Serbia, like many other radio stations in the world, decide to synchronize foreign radio broadcasts – primarily to preserve the original duration of the broadcasts, its tempo and form.

In the joint show “European Evening of Sounds” which was realized on May 29th 2023¹, it was the language barrier that was the most difficult to overcome.<fnref n="2" /> While the Serbian and Slovenian languages can be mutually understood, for the Finnish colleagues the realization of the show was impossible without simultaneous translation or a pre-agreed and translated text. With this, the conversations between the presenters could not be spontaneous, but prepared and ‘acted out’. Also, any text possibly changed on the spot would go on air without translation.

Radio and Television of Serbia, in accordance with its production standards, for all the aforementioned reasons, decided to synchronise<fnref n="3" />, edit and subsequently broadcast the “European Evening of Sounds” show, while the partners from Finland and Slovenia decided to consecutively translate presentations in direct transmission. As it is impossible to have both simultaneous translation and ‘idle running’ of consecutive translations in the same show, Radio Belgrade 1 participated live in the realization of the RTV Slovenia and YLE/University of Eastern Finland shows at 19:00 EST, while broadcasting its edition of the show with a delay, at 21:00 EST. Since consecutive translations, repetitions of texts in different languages were unnecessary in the broadcast of Radio Belgrade RTS, the total duration of the edited broadcast was much shorter, about 35 minutes in total.<fnref n="4" />

<figure><img src="image_410.png" /></figure>

<footnote n="1">1 Director: Ljubinka Dobrilović, sound recorders: Damir Godevac and Katarina Kolar, music editor: Snežana Stanojević.</footnote>

<footnote n="2">2 The international mission of the "European Evening of Sounds" was preceded by two 'national' shows. In the 90-minute debate show "Creative Europe: Sounds and Memories", broadcast on February 25, 2023 on Radio Belgrade 1 RTS, at 8:30 p.m., live broadcast recordings/conversations with elderly people were commented on by anthropologist MSc Sara Nikolić, psychologist Bojana Skorc, Ph.D. and Mirjana Nikolić, Ph.D., media theorist and rector of the University of Arts in Belgrade, with the editor and show host Nikoleta Dojčinović. The documentary show "Sound and Recollections: Pearls, Witches and Other Fables" (author Nikoleta Dojčinović, director Vesna Perić) broadcast on April 29, 2023 on Radio Belgrade 2, RTS is a skilfully designed kind of fabric of sound and memories, often on the same topics, of different people, of different memories. The documentary show represented Radio Belgrade RTS at Prix Italia 2023 (p. 147) and broadcasted on RTV Slovenia.</footnote>

<footnote n="3">3 Translator for Slovenian language: Tanja Tomazin, for Finnish language: Jasmina Teofilović.</footnote>

<footnote n="4">4 RTS+RTV Slo+YLE about 14 min, RTS+RTV Slo about 10 min and RTS+YLE/UEF about 11 min.</footnote>
<figure><img src="image_411.png" /></figure>

Broadcast of the "European Evening of Sounds" national edition – "Creative Europe: Sounds and Memories" with Mirjana Nikolić, Ph.D., Sara Nikolić, MSc, Nikoleta Dojčinović, Bojana Škorc, Ph.D., February 25th, 2023, Radio Belgrade 1, RTS.

The planned broadcast time on Radio Belgrade 1 was 60 minutes, so that time slot was during the show filled with the songs representing Slovenia<fnref n="5" />, Serbia<fnref n="6" /> and Finland<fnref n="7" /> in the 2023 Eurovision Song Contest<fnref n="8" />; after the end of the show, songs from some of the earlier editions of the Eurovision Song Contest, selected by the music editor, were broadcast. Heikki Uimonen and Helmi Järvi-luoma-Mäkelä, based in the studio in Finland, featured as guest-hosts for Radio Belgrade. Given that the "European Evening of Sounds" show was preceded by the editions of two 'national' shows – a debate with guests in the studio in February 2023 and a documentary broadcast in April 2023, the last show in this triptych of a kind had no need for interlocutors in the studio of Radio Belgrade.

Finally, the language barrier in the Radio Belgrade broadcast was overcome by delaying the beginning of the translation, which allowed the listeners to detect the origin of the language and hear its 'native melody' (Aleksić, 2019). Conditioned by the broadcaster's planned times and simultaneous/consecutive translations, the show "European Evening of Sounds" gave birth to three completely different shows, both in terms of duration and content, original, national and international, but also united the three partners of the B-AIR project in field exploration of sounds and memories.

To listen to the "European Evening of Sounds":

<figure><img src="image_412.png" /></figure>

## Sources and literature

Aleksić, M. (2019, December 31). Scholarly Conference with International Participation „Maternja melodija” Momčila Nastasijevića: Interdisciplinarne refleksije [The Native Melody of Momčilo Nastasijević: Interdisciplinary Reflexions], Belgrade, Faculty of Music [Conference presentation abstract]. New Sound, 54(2), 177–181. https://www.ojs.newsound.org.rs/index.php/NS/article/view/31

Clarke, D. (2020, November 19). Cultural Diplomacy. International studies association and Oxford University Press. Retrieved February 8, 2024, from https://doi.org/10.1093/acrefore/9780190846626.013.543

Creative Europe. (2014–2020). Creative Europe 2014–2020. European Commission. https://culture.ec.europa.eu/resources/creative-europe-previous-programmes/creative-europe-2014-2020

<figure><img src="image_413.png" /></figure>

<footnote n="5">5 Joker Out – „Carpe Diem” (https://www.youtube.com/watch?v=3LXIPviGiWc)</footnote>

<footnote n="6">6 Luke Black – „I’m Just Sleepy” (https://www.youtube.com/watch?v=E89gtz9rdBM)</footnote>

<footnote n="7">7 Käärijä – „Cha Cha Cha” (https://www.youtube.com/watch?v=rJHe-iZ5HSI)</footnote>

<footnote n="8">8 The final of the Eurovision Song Contest was held in Liverpool on May 13, 2023.</footnote>
# SLOVENIA: EVENINGS OF SOUNDS
## Production of the Radio Slovenia, RTV SLO

As a part of the B-AIR international project, a series of evenings dedicated to sounds and memories was aired on the programs of Radio Slovenia.

The first evening show, hosted by Mojca Delač, took place on Monday, 15th May 2023, on the First Program of Radio Slovenia.

The second, hosted by Anamarija Štukelj Cusma, followed the next Monday evening on the "ARS" program.

The third, internationally themed, produced collaboratively by the First Program, Val 202, and the program "ARS", with Anamarija Štukelj Cusma, Saška Rakef, Mojca Delač and Maj Valerij as hosts, was broadcast on May 29th 2023.

<figure><img src="image_414.png" /></figure>

On this and next page:
Broadcast of the "European Evening of Sounds" national edition, Radio Slovenia, RTV SLO

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# HOW DID YOUR CHILDHOOD SOUND?

Our brains have a unique way of processing auditory information and storing sounds. For many, sounds are the key information, the most important stimuli that shape the picture of the world, the surroundings, the objects, the people. Furthermore, our worlds are shaped by sound in a way we might not even recognise or appreciate enough in a visually oriented society. We aimed to understand this field more thoroughly with the “B-AIR Evening of Sounds” series, which started on the First Program of Radio Slovenia – with the episode: “What are the sound memories of your childhood?”

Nostalgia is often triggered by sensory stimuli, and this brings various thoughts, ideas, and feelings to the surface. Motivated by the years of expertise of the Finnish public radio crew, we agreed that we wanted to engage with the topic in a way that isn't too narrow but inspiring enough for a wide range of listeners to participate in. This proved to be the right decision, leading us to quite a unique, memorable radio show.

The radio library of sounds, called “Mediateka”, is an important source of different auditory stimuli. It played a crucial role in making ‘memories come to life’ when our listeners called in and shared their stories and memories. As explained by our special guest in the studio, Špela Loti Knoll, musician, music therapist and the director of the Institute Knoll for music therapy and supervision, “sounds are a

language without limits”. I believe that sometimes, being focused on the verbal expression and words, we tend to forget about this. Seemingly bombard ed with stimuli of all sorts, our focus and patience are put to the test.

All the above represented a challenge for a two-hour show where no music was played; all we had were words and sounds. I am proud and happy to say that the premiere of this show format attracted many listeners, who shared some incredible stories. From the sound of a worm chewing the wood of a bed in the sleeping room, to the sounds of the railway engine, bora wind, and horseshoes on the gravel road. All these were not ‘just sounds’, they were significant auditory memories connected to a determined place and time. Listeners remem-

bered the pitch and the tones, the exact characteristics of the sounds that were long gone. Sounds triggered emotions (mainly very positive) and still relate to past experiences that the callers did not mind sharing with us and the rest of the audience.

Following positive feedback and wide interest from the audience, I do believe that the “Evening of Sounds” deserves continuation. Carefully selected topics and the cooperation of the entire crew: sound engineers, hosts, special guests, show director and the assistants who are searching for the sound requests, are then indispensable, the solid foundation of the palace. An on-air palace of sounds and stories holding the promise of something that is at the core of radio as we knew it. It might also be its future.

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## SOUND MEMORIES OF CHILDHOOD

### From the email response of listener Blaž Mihelič to the host Mojca Delač

“Thank you so much for such a brilliant show! You couldn’t have thought of anything better! I was really surprised by how many listeners called in and how many memories and associations they shared. Very spontaneously, a tremendously colourful show was created, in which everyone could enjoy from start to finish without getting bored in any way. Of course, your broad knowledge and excellent ability to empathize with the interviewees/ listeners, even though you cannot see them, and the thoughtful comments of your special guest, Mrs. Loti Knoll, contributed to all that.

Kudos also to your entire technical team, especially for being able to find the appropriate sounds and recordings that the listeners’ memories related to so quickly! I would especially like to thank Mr. Matej Rus for a truly vivid and experienced reading of my own memories, which you nicely supplemented with that ‘antique rattle’. I felt as if I had just stood in front of our garage at home, basking in the sun and looking at the sky, saying to myself: “A few more days and we’re off to the seaside” Like those nearly 55 years ago.”

<figure><img src="image_418.png" /></figure>

Večer zvokov

<figure><img src="image_419.png" /><figcaption>“European Evening of Sounds” national edition visual, Radio Slovenia, RTV SLO</figcaption></figure>
# TO HEAR YOUR LIFE AGAIN

First experiences of the “Evenings of sounds” showed that this open radio communication form is extremely welcome for listeners, because a contact radio show connects the radio creators with listeners in a creative way. In this open broadcast, listeners choose a specific sound that is particularly meaningful to them and wish to hear it again via radio waves. With each sound, a story is then developed about what this sound means to the listener and what it reminds them of. At the same time, individual stories are accompanied by a conversation with guests in the studio, which embeds the “Evening of sounds” into a new whole each time. The sounds of the past, nature, environment and special memories create a unique and unrepeatable atmosphere. Through live conversation, in which a completely new, fresh image of life unfolds, a new context is created, which in a unique way invokes familiarity as well as openness to experiencing and remembering for each one of us.

Those evenings could be called 'evenings of echoic memory'. Namely, the sound opens the space for memory. More than that, it reveals the depth and meaning of memory, and its healing value.

Memory is one of the most interesting cognitive functions, and much more than a mere collection of old photography. As the neuroscientist D.

Siegel puts it, “Memory is more than what we can consciously recall about events from the past. A broader definition is that memory is the way past events affect future functions. How we recall the past will be determined by which components of the massive network of the brain are activated in the future” (Siegel, 2020).

Memory is closely connected to stories which our brain created out of our experiences, especially our relational experiences. In that sense, live radio broadcasting is valuable in creating stories out of the remembered sounds.

A live contact between the listener and the medium enables this access to echoic memory to be meaningful and to serve its purpose – interpersonal contact. When a listener expresses a desire to hear a certain sound, the most important thing is that someone else is also interested in their story, because it is only within the conversation and storytelling that the memory is really retrieved and reshaped. Radio, on the other hand, becomes more dialogical and present in the individual's experience.

A child remembers a lot of details without knowing it, encapsulating the feelings about a certain event, person, and himself according to how they

interpreted them at the time. When the memory is reawakened, however, the story it brings is also reassembled. By sharing the story with others, in a social environment, the connections they experienced at the time are revived. The emotion that sharing of the story evokes is pure joy and happiness.

Echoic memories, stimulated by music or sound, more often come from certain years in our lives, than from others. Most people tend to excessively report memories from when they were approximately 10 to 30 years old (Jakubowski et al, 2021). Psychologists have called it the 'reminiscence bump'. Sounds and music from the reminiscence bump period can be associated with more memories than sounds and music from other periods in our life. Our teenage years and twenties are especially important and exciting times in our lives, as we experience things for the first time.

Echoic memory has a special way of being imprinted, depending on the meaning that a certain sound has for us. When our ears hear a sound, they transmit it to the brain where echoic memory stores it for about 4 minutes. In that short time, the mind makes and stores a record of that sound so that we can recall it after the actual sound has stopped.

<figure><img src="image_420.png" /></figure>
This process is ongoing, whether we are aware of
the sounds or not. Within the short time the mem-
ory lasts, the brain decides to discard or store the
echoic memory. If the sound indicates an impor-
tant context, the brain will move the information
to short-term memory. Here, it will stay for about
20 minutes before being deleted or moved to the
long-term memory part of the brain. The length of
stay of any echoic memory in long-term memory
depends on how often you replay that information
in your mind (Nunez, 2019).

This is the reason why we remember only sounds
that had special meaning for us, being important for
our life and relationships they convey. It depends
on the specific situation. Because echoic memory
is short-lasting, our brain can record many echoic
memories throughout the day. If two different pieces
of audio information overlap and reach our ears at
the same time, the brain automatically recognizes
the two separate pieces of information, or a change
in information. It relies on the echoic memory to hold
these two pieces of information simultaneously, en-
abling us to combine sounds and to make our own
narrative out of the soundscape we were immersed
in. That is why the impairment of the echoic memory
affects our quality of daily life (Thaut, 2014).

Sensory memory, of which the echoic memory is a
part, is a largely implicit memory, which could be-
come explicit only if it is a part of the story which
has been narrated (Kinukawa, et al., 2019).

Designing the “Evenings of sounds” took place
as action research, each evening bringing its own
experiences and sounds. The story of the evening
each time developed differently. The listeners’
need for their story to be heard and accepted, for
their memory to be complemented, was revealed
very strongly.

We were mainly looking for sounds that are no
longer there (e.g. a sound of analogue telephone
ringing), but that carry a whole range of experienc-
es. Reviving those sounds was like a search for
a special period, a gentle awakening of childhood
and a longing for that most precious, innermost ex-
perience that is deeply inscribed in our inner being.

All sounds we were listening to triggered very strong
emotional reactions in listeners mostly because
echoic memory is in a large part implicit memory.
Implicit memory is a type of memory with a function
of classical mental conditioning. An event, an emo-
tion, and a sound get connected through implicit
memory. When a special sound or piece of music
is paired with a very emotional event, hearing it can
be an effective cue to bring back the strong emo-
tion that was felt at that moment.

Our long-term memory can be divided into two
distinct types, namely implicit memory, and ex-
plicit memory. Explicit memory is a deliberate,
conscious remembering of the past; it involves
things like textbook learning or experiential mem-
ories, things that must be consciously brought into
awareness. Implicit memories, on the other hand,
are our unconscious and automatic memories. For
example, playing a musical instrument, or recalling
the words to a song when someone sings the first
few words. A large part of memory takes place in
the unconscious mind.

Implicit memory can be formed by passively lis-
tening to background sounds or music. We may
even develop a preference for certain soundscape
or music pieces simply because they have been
repeatedly played to us in the background. This
psychological phenomenon is known as the ‘mere
exposure effect’. People tend to like best what is
most familiar.

Explicit memory fades in the absence of recall,
while implicit memory is more enduring and may
last a lifetime even in the absence of further prac-
tice. Explicit memory systems could become dam-
aged by conditions such as Alzheimer's disease,
while implicit memory remains almost intact.

Another spectrum of sounds that spoke to us came
from nature – the sounds of animals, the wind, the
sea and raindrops, the sounds of summer and the
sounds of winter, autumn and spring. All that is
authentic, unadulterated, and organic. Everything
that directs us to beauty, to life and the infinite my-
tery of creation.

It is as if we are looking for contact with ourselves,
with life, which does not steal attention, but directs
it to where we are most alive and present. Sounds
from nature are also sounds that often lead to the
memory of someone who shared these sounds
with us, who walked with us in the snow and lis-
tened to its creaking, who alerted us to the buzzing
of bees, watched the birds with us and listened to
the waves.

The relationship between sound, music and mem-
ory is powerful. Sound evokes powerful emotions
that then bring back memories. When we listen to a
special sound or a piece of music from years ago,
we seem to travel back to that moment. We can
feel everything as if we were there (Siegel, 2020).

One of the more interesting listeners' responses
was when the sound they wanted to hear was not
exactly what they expected. At that time, there was
a sense of disappointment, as if some living mem-
ory had died or could not be fully awakened, as if
a part of the listener's inner self had perished.
This once again confirms the fact
that memory is not static,

<figure><img src="image_421.png" /></figure>
not always objective, but is tied to countless small
details that are imprinted in our experience.

The richness of the show was precisely in the fact
that for everyone who listened to the show, a space
was opened for browsing through their own mem-
ories, for directing attention to the sound, listening
and at the same time eavesdropping on one's own
inner self and longing to get closer again to people
and events who built our inner life.

That is another reason why evenings of sound
should help us remember, help us connect and help
us remain attentive to the soundscape around, be-
tween and within us. It will help us restore our past
and regain our dignity as human beings.

Sources and literature

Siegel, D. (2020). *The developing mind* (3rd edition).
Norton.

Kinukawa, T., Takeuchi, N., Sugiyama, S., Nishiha-
ra, M., Nishiwaki, K., & Inui, K. (2019). Properties of
echoic memory revealed by auditory-evoked magnetic
fields. *Sci Rep* 9, Artikle 12260. https://doi.org/10.1038/
s41598-019-48796-9

Nunez, K. (2019, November 1). Echoic Memory vs. Iconic Memory: How We Perceive the Past. *Healthline Media*. www.healthline.com/health/implicit-memory#-testing.

Thaut, M. H. (2014). Musical echoic memory training (MEM). In M. H. Thaut & V. Hoemberg (Eds.), *Handbook of neurologic music therapy* (pp. 311–313). Oxford University Press.

<figure><img src="image_422.png" /></figure>
<figure><img src="image_423.png" /><figcaption>Immigrant ladies' sound workshop in Turku, Daisy Ladies Memory House, Muistola, Finland, September 2022
Photo by Helmi Järviluoma</figcaption></figure>

<figure><img src="image_424.png" /></figure>
<figure><img src="image_425.png" /></figure>

International
Burch
University

SOUNDSCAPE
OF WAR
# SOUND LIFELINE – SONIC MEMORY OF WAR

As outlined in the introduction of this chapter by Prof. Helmi Järviluoma-Mäkelä, part of the activities of the B-AIR project focused on sonic memories centring around the acts of remembering, and on how sonic memories are narrated.

At the International Burch University (IBU), our research has been focused on the sonic memories of war, or more specifically of the siege of Sarajevo 1991-1995 as experienced by fifteen survivors. We seek to understand how the collective sonic memory is shaped through individual memories and as a means to understand we conducted interviews with the survivors. The semi-formal interviews were filmed, transcribed and analysed through an academic prism supported by current sonic theory. The academic research was also used in the creation of three artistic works as a means of addressing the sonic war memories which include aspects of sonic trauma.

At the core of the project lies the exploration of the relationship between sound, space, memory and war. We applied a research-to-create approach to producing three artistic components – a documentary film, an electro-acoustic sound installation and a sound composition – which were

presented to the public under the same name as the project “Sound Lifeline” in the exhibition at the Historical Museum of Bosnia and Herzegovina in Sarajevo.

In addition to this summary of our research-to-create approach that resulted in the realization of the “Sound Lifeline” project, a more detailed publication has been produced by IBU and can be found on the B-AIR project website.

## Architecture and sound

In sonic studies, ‘aural’ and ‘acoustic architecture’ are two terms that are often used, but it is important to understand their distinctions. Acoustic architecture is concerned with the tangible, physical aspects of sound within an architectural context, aspects that can be empirically measured and assessed. In contrast, aural architecture encompasses the more intangible elements: the emotional, behavioural, and physical reactions elicited by sound within a space. This research is anchored in the aural dimension of architecture and its influence on sonic memory, both at individual and collective levels. Current academic discussions

about sound are rich with spatial ideas that extend across physical, sensory, geographic, social, and political dimensions. Frequently encountered terms include ‘acoustic spaces’, ‘soundscapes’, ‘aural architectures’, ‘auditory perspective’, ‘acoustic communities’, ‘urban ambiances’, and ‘acoustic territories’, among others<fnref n="1" />.

R. Murray Schafer, a Canadian composer, ecologist, and author, initially used the term ‘soundscape’ to describe the auditory landscape or transient composition of layers of acoustic data within an area (1977/1994)<fnref n="2" />. Whether they are purposefully created, aural architecture and soundscapes nonetheless exist. The built environment and soundscapes are inextricably linked to one another since the latter amplifies and modulates the former, while the former is made up of the accumulation of daily activities, which together make up the ‘soundscape’. So, in addition to being a representation of a place, a soundscape can also be conceived of as an expression of its social structure and physical environment.

<figure><img src="image_426.png" /></figure>

<footnote n="1">1 Refer to, for instance, concepts such as ‘acoustic space’ (Carpenter et al., 1960; Truax, 2001), ‘aural architecture’ (Truax, 1978; Blesser et al., Salter 2007), ‘soundscape’ (Schafer, 1977/1994; Thompson 2002), ‘aural landscape’ (Thompson, 2002), ‘auditory landscape’ (Corbin, 1998), ‘urban ambiances’ (Thibaud, 2011), and ‘acoustic territory’ (LaBelle, 2010).</footnote>

<footnote n="2">2 To see the whole website of “World Soundscape Project” at Simon Fraser University: https://www.sfu.ca/sonic-studio-webdav/WSP/index.html</footnote>
Here a soundscape is positioned as 'an environment of sound' (or sonic environment), with emphasis on the way it is perceived and understood by an individual or by a society'.<fnref n="3" /> In this regard, space is in the sounds, at least in a manner perhaps not too far removed from Henri Lefebvre's conception of space as a function of social production (Lefebvre 2019). Therefore, in order to understand any given sonic environment, one has to understand the semiotics of sound which functions through the experience of the auditor, who interprets meaning within their environment through the act of listening.

## Soundscape of the siege

Fifteen participants were interviewed about their sonic memories of the siege period. The participants ranged in age and occupation, and they also lived in different parts of the city during the siege. All the witnesses are aware of the soundscape of Sarajevo before, during, and after the siege. The interviews were conducted in a semi-formal style in the studio environment at the International Burch University, either in Bosnian or English. Albeit informal, the questions were structured to reflect the multitude of spatial scales and variety of daily experiences, or sonic environments, during the war. The questions did not explicitly focus on ballistic sounds or 'sounds of terror' but rather tried to understand how the siege affected spatial morphology and the daily routine conducted in it, and how that was reflected through the soundscape and what physiological effects it had on the witnesses both during and after the war. For this very reason, the name of the project is "Sound Lifeline".

The interviews have been conducted with the incredible generosity, openness and honesty of the following fifteen participants: **Adela Jusić** (visual artist), **Adi Sarajlić** (sound producer), **Dina Memić** (historian and curator at the Historical Museum of BH), **Džemil Hodžić** (video editor/founder of Sniper Alley project), **Enes Zlatar** (musician), **Enrico Dagnino** (photojournalist), **Husein Mahmutović** (musician/artist), **Mirsad Tukić** (sound engineer and artist), **Mirza Ćorić** (musician), **Nermina Zildło** (art historian and curator), **Nihad Ćengić** (architect and professor), **Nihad Kreševljaković** (historian and director of MESS festival), **Paul Lowe** (photojournalist and lecturer), **Sabina Tanović** (architect and researcher), and **Zoran Doršner** (architect).

The interviews were transcribed and analysed as a means of understanding the war soundscape and its impact on the witness. The analysis relies on the current war theory studies (Velasco-Pufleau, 2021; Goodman, 2012; Daughtry, 2015) as well as relationships between music, sound and violence (Daughtry, 2015; Gilman, 2016; Grant et al., 2013; Nuxoll, 2015; Ouzouniann, 2021; Rice, 2016; Velasco-Pulfeau, 2020; Williams, 2019). However, while most of these studies have focused on wartime and detention contexts and the experience of the soldiers (with the exception of Velasco-Pufleau, 2021, who interviewed civilian victims of a terrorist attack during a rock concert), this research explores the particularities of listening to the experiences of people – civilians – who were exposed to long-term sonic violence during the siege of Sarajevo. Through the individual testimonies, many collective patterns emerge within the sonic remembrance of the witnesses.

## Addressing sonic war memories

Although our investigation lies at the intersection of sonic memory and the architectural/spatial realm of wartime Sarajevo, it is also influenced by anthropological, artistic, therapeutic and musical spheres. The goal of the project was to investigate alternative models of addressing sound memory/trauma by resting on current warscape theories as examined through the interviews, but also through the production of the three artistic components mentioned above: an electro-acoustic sound composition, a documentary film and a sound composition.

The examination of the testified war sounds was approached in a very similar manner as one would with an architectural project – starting with the city scale and working our way down to the street level, followed by interior spaces and finally looking at it from a human scale. All three artistic components were also conceptually arranged in this manner and each has its own specific purpose within the project. For the exhibition, rather than drawing scientific conclusions about the nature of auditory experience in wartime, we asked the visitor to participate in the witnessing, experiencing the restorative nature of the sonic realm through active listening.

The three artistic components which resulted from this research: a documentary film, an electro-acoustic composition and a music composition, have been exhibited at the Historical Museum of Bosnia and Herzegovina in Sarajevo (26. 4 – 10. 5. 2023) followed by an exhibition at the Research Centre of the Slovenian Academy of Arts and Science as part of the Global SpecifCity Festival in Ljubljana organized by Radio Television Slovenia (15–18. 6. 2023).

<figure><img src="image_427.png" /></figure>

<footnote n="3">³ ISO 12913-1:2014(en), Acoustics - Soundscape - Part 1: Definition and conceptual framework, available online: https://www.iso.org/obp/ui/#iso:std:iso:12913:-1:ed-1:v1:en (accessed 1 September 2022).</footnote>
## "Narrating the Siege"
Documentary film

Since the act of witnessing publicly becomes a testimony, the documentary film "Narrating the Siege" (2023) by Lejla Odobašić Novo and Emir Klepo is the spoken testimony of the fifteen witnesses interviewed for the project. The film focuses on sonic memories of the siege as the central element of the war experience. As Anna Papaeti asserts, the process of witnessing, "emerges as an ethical moment that calls us to make sense and respond to these stories, their multiple versions and voices, in ways that open up the debate about the violence and abuse of the past and the present" (Papaeti, 2020).

Odobašić Novo and Klepo's documentary film "Narrating the Siege" and Sahačić's electro-acoustic composition "Symphony of the Siege" are complementary. The documentary film contextualizes the electro-acoustic sound composition through the testimonies. In terms of the sonic narration, both pieces are arranged in the same spatial sequence, starting with that of sounds at the city scale and moving down conceptually to the sounds of the street level, followed by the sounds of interior spaces and finally ending within the human scale and the sound of intimate personal experience. Much like "Symphony of the Siege" composition, the film "Narrating the Siege" begins with the sound of a military plane and ends in a very intimate space, that of personal loss. Changing of the spatial scales allows the viewer/listener of the exhibition to understand the all-encompassing sensory experience that sound created during the war.

The documentary progresses down in spatial scale through four parts: "Sound of War", "Sound as Orientation and Movement", "Sound of Resistance", and

"Silence", each part corresponding to the soundscapes. The final scene of the film occurs in a very intimate space and recounts a personal loss, where Džemil Hodžić testifies about the day a sniper killed his older brother Amel, while he was playing tennis with his friends in front of their house. The overwhelming silence ends the film, leaving the viewer to absorb all the testimonials and preparing them to move into the dark gallery where they can listen to the electro-acoustic sound composition "Symphony of the Siege" followed by the music composition "Peace".

The changing of the spatial scales in all three pieces allows the viewer/listener of the exhibition to understand the all-encompassing sensory experience

related to the sound during the war. The goal of the documentary is to illustrate the transformative nature of the sounds during the siege. It started as a tool of terror and oppression through ballistic sounds; however, as the war progressed, the citizens learned how to use it as a tactical means of survival and finally even adapted it as a tool of resistance through activities such as concerts, music plays and radio. The notion of resilience, empowerment, and resistance through sound becomes the underlying message of the film.

To watch the documentary film "Narrating the Siege"

<figure><img src="image_428.png" /></figure>

<figure><img src="image_429.png" /></figure>

From recording the interviews with war survivors. Photo by IBU Graphic Department

<figure><img src="image_430.png" /></figure>
## "Symphony of the Siege" Electro-acoustic composition

The electro-acoustic composition "Symphony of the Siege" by Haris Sahačić is an attempt to spatialize and recreate some of the key experiences described as sound memories through the fifteen testimonies. Psychological research and practice have shown that imprints from the past can also be transformed by having physical experiences that directly contradict the helplessness, rage and collapse that encapsulate trauma.

"Symphony of the Siege" is a recreation of sonic experiences with new sequences and spatial order, based on the narrational testimony. The aim of the work within the project research is two-fold. The first aim is to re-introduce the war sounds to the witnesses in a safe and reconceptualised space and sequence, and in this way, as stated above, the protagonist/witness is able to replay and change scenes from their past and thus 'normalize' the war sounds through listening to the composition. The second is to introduce those sounds to the visitors of the exhibition who have not experienced the siege of Sarajevo, again in a safe and controlled environment with a carefully composed flow, as a means of better understanding the survivors and their testimonies.

The electro-acoustic composition is acoustically projected through six active sound monitors in a pitch-dark gallery and thus creates a sense of spatial depth through sonic projection. The piece is composed as a symphony consisting of four acts (based on four spatial scales), each consisting of a number of sound miniatures. Each sound miniature is a recreation of one acoustic moment described by the witnesses. The flow and order of the miniatures is also reflected in the structure of the documentary film. The spatial scales of the sound scenography

move from the entirety of urban territory to the space of an intimate moment. As Judith Herman asserts, "the fundamental stages of recovery are establishing safety, reconstructing the trauma story, and restoring the connection between survivors and their community" (Herman, 2015).

To listen to the "Symphony of the Siege":

<figure><img src="image_431.png" /><figcaption>Interview with war survivors. Photo by IBU Graphic Department</figcaption></figure>

<figure><img src="image_432.png" /></figure>

<figure><img src="image_433.png" /></figure>
## “Peace” Sound Composition

Mirsada Zećo's sound composition “Peace” is the third part of the exhibition and is based on music and therapeutic theories. The performance of the sound bath has been pre-recorded and is also structurally based on the narrowing of the sound scales as the performance progresses, ultimately ending in silence. The “Peace” is played in the same space and right after Sahačić’s “Symphony of the Siege.” Thus, the role of this sound bath is to regulate the sonic distress that the visitor might experience after listening to the electro-acoustic piece.

“Peace” is based on well-established music theories as pertaining to its therapeutic usage. The sound bath performance was pre-recorded as a form of therapeutic model. The intensity and strength of the sound of the planetary gong Venus (221,23 Hz) were related to extreme sounds during the period of the siege (**forte, fortissimo**) in order to continue with the calming and subtle sound variations on sound bowls. Mirsada used three different therapeutic bowls (Hess, 2008): a small bowl (frequency scope of 200 and 1.200 Hz), a medium bowl (frequency scope between 100 and 1.100 Hz) and a large bowl (frequency scope between 100 and 2.800 Hz). Each of these sound bowls also resonates with certain organs in the body, bringing the listener into a quicker state of relaxation.

To listen to the “Peace”:

<figure><img src="image_434.png" /></figure>

<figure><img src="image_435.png" /><figcaption>Listening to the sound compositions. MESS Festival, April 26th, 2023. Photo by Velija Hasanbegović</figcaption></figure>

<figure><img src="image_436.png" /></figure>
Restoring safety

The project “Sound Lifeline” aims to explore the relationship between architecture, sound, memory and war through the witnessing of fifteen survivors of the siege of Sarajevo 1991-1995. By the means of these testimonials it was possible to trace the transformative agency of sound from that of weap- on of war and psychological torture by perpetra- tors, to that of a tool of orientation and movement in space by the citizens of Sarajevo and finally as a means of resistance through music and radio. The research also portrays the relationship be- tween sound and architecture in extreme circum- stances and furthermore it explores how artistic components which resulted from this research (a documentary film, an electro-acoustic composition and a sound composition) were placed in a safe environment.

<figure><img src="image_437.png" /><figcaption>Sound Lifeline, MESS Festival. Photo by Amina Alić</figcaption></figure>

<figure><img src="image_438.png" /></figure>
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Goodman, S. (2012). *Sonic Warfare: Sound, Affect, and the Ecology of Fear*. MIT Press.

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Grant, M. J. (Guest ed.), & Papaeti, A. (Guest ed.) (2013). Thematic issue Music and torture | Music and punishment. *World of music (new series)*, 2(1). https://www.jstor.org/stable/i24316991.

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<figure><img src="image_439.png" /></figure>
SOUNDART
AND MEDICINE

<figure><img src="image_440.png" /></figure>

<figure><img src="image_441.png" /></figure>
**Manca Kok, MSc Psychology**

University of Amsterdam, the Netherlands

**Ana Kuder, Division of Neurology,**

Institute for Clinical Neurophysiology,
University Medical Centre Ljubljana, Slovenia

**Saška Rakef**

Radio director, Radio Slovenia, RTV SLO

**Prim. Igor Mihael Ravnik, MD**

Centre for epilepsy (paediatric)
University Medical Centre Ljubljana, Slovenia

katarina.kurtjak@gmail.com

ana.kuder@kclj.si

sasa.rakefperko@rtvslo.si

iravnik@yahoo.com

INITIATING THE USE OF MUSIC IN HEALTHCARE:
THE EXPERIENCE OF THE B-AIR PROJECT

Throughout history, music has played an important role in alleviating physical and mental ailments. It is only in recent decades, however, that systematic scientific research into the benefits of music has become widespread. In the framework of the B-AIR project, the authors of this article came together to explore possible ways of promoting the idea of introducing music into the Slovenian healthcare system.

Our project is based on the vast literature supporting the positive role that music can play in healthcare – combining rehabilitation effects on cognition, speech, movement and social aspects. Seeing that music is not part of standard medical practice in Slovenia, we devised an action plan, with the aspiration to start promoting music as an important factor in the Slovenian healthcare system. Our efforts have been put into practice: we have prepared webinars and radio broadcasts (“Soundings”/Zvočenja), and introduced a hospital radio prototype for children at the Paediatric Clinic

of the UMC Ljubljana. Further, a pilot study among musically active doctors was performed to assess the needs and prospects felt by the medical personnel regarding introducing music into their practice. The study confirmed our assumption – there is a lack of knowledge and systematic education about the positive effects of music.

The findings also directed our future efforts. Musically active doctors expressed a desire for more research about the impact of music and several comments have been made regarding the exploration of the patients' perspective. We performed a study on the use of music and the interest to use music in people with Parkinson's disease, especially focusing on the members of Parkinson's disease association of Slovenia – Trepetlika. With the study, we wanted to dually address the need for trial periods and pilot studies. We wanted to give an experience of music therapy and simultaneously research its impact on patients, thus bringing them closer to medical professionals.

As B. Polascik and colleagues (2020) reported, acceptance of music interventions requires time and education. We want to enable this through the gradual introduction and further spreading of awareness through mass media and in professional circles: discussing medical problems among musicians and continuing the creation of radio conversations, seminars and workshops for professionals in music and medicine. Through these efforts we hope that music will gradually take on a more important role in the Slovenian healthcare system.

The B-AIR project and the
theoretical background

Music is present in humans from before birth. Even newborns show the ability to discriminate and show interest in singing and different musical instruments (Babikian et al., 2013). Music has a rich and extensive history in the field of medicine, with its use

<figure><img src="image_442.png" /></figure>
spanning across different cultures and time peri-
ods. The first person to use music as a remedy for
physical and psychological problems was Pythag-
oras in the sixth century B.C. However, it is only in
recent decades that systematic research into the
therapeutic utility of music in clinical practice has
begun (Babikian et al., 2013). Research on the po-
tential clinical applications of music has been fol-
lowed by studies on the brain mechanisms of mu-
sic perception (Blood et al., 2001; Molnar-Szakacs
et al., 2012; Schaefer et al., 2013, Vines, 2012; Wu
et al., 2012), which have shown positive effects on
a wide range of neurological functions (Blood et
al., 2001; Molnar-Szakacs et al., 2012; Schaefer
et al., 2013, Vines, 2012; Wu et al., 2012). The au-
thors of these studies have estimated that similar
brain regions are activated during the perception
and processing of musical experiences as with
experiences of reward, motivation, emotion and
arousal. Listening to music alone activates more
brain regions than any other stimulus – activation
starts in the brainstem and then continues to more
highly developed structures up to the frontal cor-
tex (Molnar-Szakacs et al., 2012). A wide range of
neural networks are crucial for the brain's process-
ing of music, from emotional perception to motor
and somatosensory functioning (Babikian et al.,
2013). The discoveries in the field of neuroscience
have greatly contributed to raising awareness and
acknowledging the significance and effectiveness
of music as a therapeutic approach. Music is ac-
knowledged as a useful tool in neurorehabilitation,
as it has the unique ability to activate a wide array
of neural networks that are not exclusive to expe-
riencing music, but are primarily responsible for
speech, movement, cognition, etc. For example,
in the USA and Canada, one type of music thera-
py (rhythmic auditory stimulation – RAS) has been
included in the official guidelines for stroke rehabil-
itation in 2019 (Thaut, 2021).

In a large-scale international and multidisciplinary project B-AIR, the public institution RTV Slovenia (Radio Slovenia), together with eight partner organisations from seven European countries, explores and questions the role of sound art and the auditory channel in perception, cognition, communication and socialisation in human development, health and disease. Artists, experts from various fields (from neuroscience, developmental psychology, paediatrics, music pedagogy, musicology to architecture, anthropology, sociology) and journalists collaborate to produce musical, fictional, informative, educational and research content. The content is aimed at children, parents, educators, teachers, health professionals and anyone else interested in what sound and sound-based art can bring to human cognitive, emotional and personal development.

The project also served as a starting point for incen-
tivizing the use of music in the Slovenian healthcare
system. Recognising that the use of music therapy
in Slovenia is not yet as well developed as in some
other European countries, the project members
developed an action plan to encourage the medi-
cal professionals and the general public to consid-
er music as an important factor in the Slovenian
healthcare system. In the following, we first present
some of the achievements of the project.

Musically active doctors' views on the role of
music in healthcare

In May 2021, we conducted a brief survey targeting
doctors in Slovenia to investigate their interest and
motivation regarding the integration of music into
the healthcare system. The purpose of this survey
was to gain insights into the possible benefits and
potential barriers associated with incorporating
music as a therapeutic tool in medical settings. By

directly engaging with the medical community, we
aimed to understand their perspectives and gath-
er valuable information that could inform future ef-
forts to enhance patient care through music-based
interventions.

16 musically active physicians participated in the pilot survey (response rate was 32%), half of whom (N = 8) were women. Participants were contacted mainly through links in the existing networks (originating from chamber ensembles, string orchestra and choirs) of musically active physicians. As the sample size was small, we cannot speak of statistical significance and hence report only the patterns we observed using descriptive statistics and by categorising the written responses to the open-ended questions.

The questionnaire first aimed to assess the current
state of music use in healthcare (results are given
as percentages to facilitate clarity and readability).
62.5% of the doctors surveyed had previously en-
countered music in healthcare. As examples they
mentioned special events for patients, music in
waiting rooms, during surgery and doctor's office.
They indicated that they themselves already use
music in the following situations: radio in the de-
ivery room, personal choice of music in the irradi-
ation rooms, music listening during the premature
baby's contact with the parent, and generally to
improve the patient's mood.

Furthermore, the survey aimed to assess the phy-
sician's awareness of the potential benefits of mu-
sic and their attitudes towards the introduction of
music in healthcare. Although the sample includ-
ed only doctors with extensive music experience,
only one person was confident that they had
a fair understanding of the benefits
of integrating music into

<figure><img src="image_443.png" /></figure>
healthcare settings. Most participants were at least somewhat aware of the benefits, and all of them felt that healthcare professionals should be systematically educated about it. 75% of the doctors interviewed were enthusiastic about the idea of introducing music into medicine, while the remainder, although enthusiastic, had concerns about potential barriers.

The respondents were asked about the feasibility of 6 examples of introduction of music in healthcare situations. Figure 1 shows how many of the participants found each idea feasible. When asked about the potential difficulties of introducing music, obstacles were perceived to exist in the resistance from management, uncertainty about whether

such interventions were really necessary or useful, and lack of energy and time. In addition, infrastructure and lack of funding for sufficient technical equipment were highlighted as potential barriers. The diversity of musical tastes was also seen as a significant problem. Many felt that a trial period would be most effective in preparing the staff. Some suggested starting with a survey and one participant proposed a clear plan that would inform and convince the management and staff. Participants would like to see more research on what kind of music is universally soothing, the effect of music on psychological tension during radiation, on chronic regional pain syndrome (CRPS) and on developmental speech disorders.

Which of these do you perceive as feasible?

<figure><img src="image_444.png" /><figcaption>Figure 1: Six examples of introducing music into the health system that the participants (N = 16) found most feasible</figcaption></figure>

Music is one of the most universal types of therapy due to its proven benefits for overall well-being, several neurological functions, and its cost-effectiveness. The risks of side-effects are also minimal or non-existent and music can be used in a wide range of clinical populations and age groups (Babikian et al., 2013). However, there are many genres of music available to us and people have developed a variety of musical tastes. Hence, despite being a highly applicable and universal phenomenon, music is also highly individualistic (Babikian et al., 2013). This can be a problem when trying to generalise its effectiveness for a group of people (e.g. in a waiting room), which was also pointed out by the participants in our study. A growing body of research reports the benefits of the therapeutic use of personalised music for well-being (Martin et al., 2016; Park et al., 2016; de la Torre-Luque et al., 2017; Sung et al., 2010, cited in Dimopoulos-Bick et al., 2019).

Genevive A. Dingle et al. (2021) provided a review of the extant literature on the psychosocial mechanisms through which musical activity may contribute to improved health and well-being. The featured mechanisms were emotion regulation and the promotion of social connectedness, cognitive stimulation and physical activation. The presence of these mechanisms may vary depending on the type of music intervention. The heterogeneous nature of the existing research and the inconsistent quality of the findings make it difficult to draw definitive conclusions about the effectiveness of different music interventions. Among the variety of ways in which music can be incorporated into medical practices, researchers recommended the use of music as a complementary therapy for various health problems, as an aid to regulate emotions and reduce stress and so on.

<figure><img src="image_445.png" /></figure>
For improving physical fitness and coordination, they recommended performing dance or movement activities, and for more successful social integration and cognitive stimulation they encouraged music-making. They pointed out that music interventions should be culturally sensitive and tailored to the individual's needs. Further, they warned that not all music interventions are equally accessible (due to technical equipment or training of health professionals) (Dingle et al., 2021).

One of the interventions that are most accessible and adaptable to the individual is the use of personalised playlists, which has been studied by Tara Dimopoulos-Bick et al (2019). In their study, 76% of patients reported a positive change in their health experience as a result of using a personalised playlist. Healthcare staff felt that the use of personalised playlists was convenient mainly due to ease of administration. Volunteers can be invited to help with the administration of personalised playlists as administration does not require specific qualifications, which was also one of the concerns raised by healthcare staff in our pilot study. Nevertheless, the authors stated that the support of music therapists in the implementation of music interventions is recommended. The study implementers provided training and technical support to healthcare staff before and during the study. Approximately half (51%) of healthcare staff felt that this prepared them fairly well or very well for their role in implementing a music intervention, which is consistent with our participants' views on the importance of staff preparation and the trial period of introducing music into the healthcare system. A music intervention such as the use of a personalised music playlist can be easily embedded into routine healthcare practice. On the other hand, healthcare staff reported some similar barriers to the use of personalised music playlists as those

raised by participants in our study, including funding for technical equipment and other infrastructure to deliver the interventions (e.g. equipment storage, internet connection) and increased workload for those delivering the interventions. Breanna A. Polascik et al. (2020) report similar concerns of healthcare staff about perioperative music use, including reduced patient interest in listening to music, unstable patient turnover timeframes, and additional workload for healthcare staff. The authors report that the acceptance of music interventions by healthcare staff (nurses and anaesthetists) has increased over time (Polascik et al., 2020).

The survey described above served only as a pilot, so we designed a follow-up in summer 2021, with the aim of obtaining a larger sample, but we received only three responses. The current results therefore do not allow us to draw any conclusions about the general opinion of the medical sector, including musically inactive doctors and patients themselves. We do not believe that the exclusive use of online surveys to gain insight into the mindset of healthcare staff is an appropriate way to do this. Healthcare staff is generally overburdened, especially during the Covid pandemic which limited us in methodological terms – we were unable to meet respondents in person. Except for one occasion, the motivational meetings we planned with musically active doctors (orchestra, chamber ensembles, choir) could not be carried out. To gain a more comprehensive understanding of healthcare staff attitudes towards music, it would be more valuable to first conduct qualitative research, such as focus groups. Following this, a questionnaire can be administered to a larger sample, encompassing various groups of healthcare professionals. In the future, we could use a similar methodological approach to Tara Dimopoulos-Bick et al. (2019), who collected questionnaire responses from patients,

family members and healthcare staff, conducted six focus groups with healthcare staff representatives, and analysed various documents about the interventions and the study. This approach could gain access to a holistic view of the issue, since, according to the authors, patients and their families are also the key actors in the introduction of music in the health system.

## Disseminating knowledge through the medium of radio and beyond

Radio is a cost-effective and important source of education, information and entertainment that can easily reach a wider audience (Rahman Ullah and Khan, 2017). A public medium (in this case, radio), with a project that is initially focused on creative arts content, can stimulate a wide network of collaborations that also generate ideas and proposals that can lead to research, development and organisationally significant shifts in the field of comprehensive care for the development, quality of life and treatment of children and vulnerable groups. The material we have generated through a series of radio talks, webinars and lectures will be useful for thematic discussions and for disseminating knowledge to professional and lay audiences about the impact of music on health and quality of life.

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## B-AIR "Soundings" (Zvočenja) project and webinars

This is a series of expert talks on the use of music in healthcare with eminent guests from leading European centres, led by Igor Mihael Ravnik, MD, sen-

ior specialist in paediatric neurology. The aim of the interviews is to disseminate knowledge and experience from international good practices, to promote use of music in the Slovenian healthcare system, to increase interest in research as well as raise awareness of the positive effects of music in society.

The project group also organised webinars. B-AIR joined forces with the student section of SiNAPSA, the Slovenian Neuroscience Association, to organise these webinars, which can be seen in Table 1.

<table><thead><tr><td>Guest</td><td>Institution</td><td>Topic</td></tr></thead><tbody><tr><td>Darko Breitenfeld</td><td>Croatian Association of Alcoholics' Clubs, Zagreb</td><td>Beginnings of music therapy in Central Europe</td></tr><tr><td>Ivan Rektor</td><td>Centre for Neuroscience, Masaryk University in Brno</td><td>Mozart's Sonata K448 for two pianos and epilepsy</td></tr><tr><td>Giuseppe Pino Poclen, Vali Glavič Tretnjak</td><td>Lo Specchio Sonoro, Desio; Division of Paediatrics, UMC Ljubljana</td><td>From musical education to musical animation and non-verbal music therapy I, II</td></tr><tr><td>Mihaela Kavčič</td><td>Ad Libitum, Logatec, Department of haemato-oncology, Division of Paediatrics, UMC Ljubljana</td><td>Music therapy for children with cancer and people with dementia</td></tr><tr><td>Stefan Koelsch</td><td>Department of Biological and Medical Psychology, University of Bergen</td><td>Music and the brain</td></tr><tr><td>Clement Francois</td><td>Speech and Word Laboratory, Aix-Marseille University</td><td>Words, speech and brain plasticity</td></tr><tr><td>Manuela Filippa</td><td>University of Aosta, University of Geneva</td><td>The newborn and the mother's voice</td></tr><tr><td>Katarina Kompan Erzar</td><td>Faculty of Theology, Faculty of Education, University of Ljubljana and SFU Ljubljana</td><td>First steps in the world of sound and music</td></tr><tr><td>Miran Možina</td><td>Sigmund Freud University Ljubljana</td><td>Psychotherapy, music and dance therapy</td></tr><tr><td>Irena Hočevar Boltežar, Nataša Prebil, Rozalija Kušar in Petra Bavčar</td><td>Centre for Voice, Speech and Swallowing Disorders, Department of ENT and Cervicofacial Surgery, UKC Ljubljana</td><td>Voice, speech, singing</td></tr><tr><td>Saba Batellino</td><td>Audiovestibulosis Centre, Department of ENT and Cervicofacial Surgery, UCC Ljubljana</td><td>Hearing and pitch</td></tr></tbody></table>

<figure><img src="image_447.png" /></figure>
<table><caption>Table 1: List of guests and topics of “Soundings” programmes</caption><thead><tr><th>Guest</th><th>Institution</th><th>Topic</th></tr></thead><tbody><tr><td>Andre Lee</td><td>University of Music, Theatre and Media, Hannover</td><td>Physiology of music and medicine for musicians</td></tr><tr><td>Ladislav Krapac, Iva Bartolić</td><td>Physical medicine and rehabilitation outpatient centre, Zagreb</td><td>Physiology of music making and medicine for musicians</td></tr><tr><td>Peter Vuust</td><td>Royal Academy of Music, Aarhus University</td><td>Research in the Center for music in the brain I, II</td></tr><tr><td>Andrej Adamek, Janja Hana Jamnikar</td><td>Dept. of Neurology, Dept. of haemato-oncology, Division of Paediatrics, UMC Ljubljana</td><td>Art for children in the hospital</td></tr><tr><td>Jaka Škapin</td><td>Luminelle's, London; Dancing with Parkinson's Project</td><td>Singing, speech, dancing with patients</td></tr><tr><td>Jamie Wilcox, Chaminda Stanislaus</td><td>Radio Lollipop, Great Ormond Street Hospital, London</td><td>Hospital radio for children</td></tr><tr><td>Matevž Pesek</td><td>Faculty of computer and information science, Ljubljana University</td><td>Human and computer interactions with music</td></tr><tr><td>Maria Majno, Luisa Lopez</td><td>Fondazione Pierfranco e Luisa Mariani, Milano</td><td>The Mariani Foundation's activities in child neurology including neurology and music</td></tr><tr><td>Jiry Mekyska, Tomas Kiska, Stepan Miklanek</td><td>Polytechnic University Brno, Laboratory for Analysis of the Brain</td><td>Listening to and analysing music with the help of a computer</td></tr><tr><td>Daniele Schon</td><td>Neuroscience Institute of Systems, Marseille</td><td>With music into the brain for knowledge and health</td></tr><tr><th colspan="3">Webinars with SiNAPSA</th></tr><tr><td>Rebecca Schaefer, Johanna Perschl</td><td>Leiden University</td><td>Neuropsychology of music processing and movement rehabilitation with music</td></tr><tr><td>Gregor Geršak, Carlos Jurando, Leonie Ascone Michelis</td><td>University of Ljubljana, Universidad de Las Américas (UDLA, Ecuador), University Medical Center Hamburg-Eppendorf</td><td>The impact of ultrasound and infrasound on human functioning</td></tr><tr><td>Katarina Kurtjak, Briana Applewhite, Supritha Aithal</td><td>School Centre Novo mesto, University of Oxford, Edge Hill University</td><td>Autism and music</td></tr></tbody></table>

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All of this content was aimed at both the general and professional public. By creating different types of content, we tried to reach the general public in a way that tries to satisfy a range of listeners. Interest was in parallel also actively triggered via personal contacts in professional networks. Examples of positive feedback were: a wish to invite a few of the interviewed researchers to planned educational and research events at the universities (e.g. in perinatology), to specialist meetings (e.g. neurophysiological association), to the doctoral students of several programmes (e.g. psychology, biomedicine) etc.

In the general public, reactions depend on the intrinsic motivation of listeners and participants for self-education through radio and mass media. This is because the use of mass media can stem not only from a desire for self-education but also from various social and psychological needs (such as cognitive needs, emotional needs, personal integrative needs, social integrative needs, and tension release needs) (Hass (1973), as cited in Rahman Ullah and Khan, 2017).

The content has certainly had an impact, although perhaps limited to certain audiences. It is yet not possible to assess the influence these broadcasted discussions with eminent researchers in the field have had in our society. The interviews were broadcasted at 11 a.m. when active staff in healthcare cannot follow the programmes. A number of positive feedback reactions came mostly from retired physicians, but we have no data on the percentage of other professionals having listened to it. We will further need to try motivating them by publishing and promoting the podcasts aimed at the professional public and addressing specific topics in focus groups of interest (specialist associations, NGOs, parent associations, musically active health staff - e.g. we presented our work to the Camerata Medica Strings).

## The Hospital radio

The idea of Hospital Radio was conceived to bring together renowned experts from different disciplines and artists. The aim is to create sound content for hospitalised children and to apply knowledge of the effects of soundtracks to the production of new music and radio works that contribute to the cognitive, emotional and personal development of children.

As a primary goal, radio relaxes, entertains and educates – it serves as a model for the use of music and words for specific situations, such as calming pre- and post-operative anxiety in children. As a secondary objective, it draws attention to noise levels and encourages parents to consider quality of life outside the hospital, including time for quality acoustic medium products (music, verbal contents) in their homes, nowadays predominantly offering children visual and screen time. The first hospital radio prototype was implemented for children at the Ljubljana's Children's Hospital in the course of the B-AIR project (2021/2023).

## Spreading the word

B-AIR team members presented the project activities at two conferences – in June 2021 we attended the "NeuroMusic VII: Connecting with music across the lifespan" conference in Aarhus, Denmark, and in September 2021 we attended the SiNAPSA neuroscience conference – SNC'21, where we also organised a symposium "Music and the brain" and presented a poster about the project activities at the Congress of Neurologists in 2022, after which a series of meetings led to establishment of a working group with specialists from the Department of Neurology, University Medical Centre Ljubljana.

The symposium "Music and the brain" offered an insight into the latest research, findings, practice and open challenges in various fields of expertise to the people in the neuroscience field. The speakers and the titles of their speeches at the symposium were: Stefan Koelsch (University of Bergen): "Research towards evidence-based music interventions"; Daniele Schoen (University of Aix-Marseille): "Neurology of music and the brain"; Uroš Kovačič, MD, PhD (University of Ljubljana): "Heart rate variability in relation to music genres"; and Manuela Filippa (University of Geneva): "Early music interventions in infants". Manuela Filippa also hosted a workshop in June 2022 for the Slovenian paediatricians, perinatologists, and child psychiatrists on the role of mother's voice in early development.

A part of the project was also presented in the weekly educational TV show "A bite into science" (Ugriznimo znanost) on RTV Slovenia.

A part of the project activities was also presented at the International symposium "Opening the doors to the art and science of music", hosted by the University of Ljubljana Academy of Music and at the B-AIR Symposium "Sound and music in the lived experience of infants, babies and vulnerable groups".

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## Pilot study of music therapy in people with Parkinson's disease (PD)

Methods using music and rhythm can significantly improve a wide range of symptoms in neurological and non-neurological disorders. A good example is Parkinson's disease, in which music interventions are already being used to alleviate symptoms of the disease (Thaut and Hoemberg, 2014). In a review article, Kerry Devlin et al. (2019) point out that recent research has demonstrated the usefulness of music and rhythmic interventions to improve symptoms of people with Parkinson's disease, such as gait impairment and other motor and non-motor symptoms. In Slovenia, some forms of music and dance interventions (especially dance workshops) are being used (non-systematically), especially as a part of activities offered by the Parkinson's Disease Association of Slovenia – Trepetlika (a national NGO with regional network). In Slovenian healthcare, music has not been systematically implemented as a complementary treatment for people with Parkinson's disease.

In Slovenia, we have not yet identified any major research studies examining the impact of music interventions on PD. The aim of our study was to explore the patients' perspectives on the current use of music for alleviating PD symptoms, evaluate current attitudes towards the use of music or musical interventions in the healthcare system and assess their willingness to participate in possible further studies of musical interventions on PD symptoms. In a group of 79 people with PD (most of whom were members of Trepetlika), half of the respondents reported already using music for alleviation of PD symptoms, especially as a way to regulate their mood. In a group of participants that do not yet use music to help with PD symptoms, most of them would be interested in doing so but

would need help in the form of pre-prepared music, reminders to dedicate a specific amount of time for music listening and assistance in the music setup. When asked about their interest in further participation in the studies of music intervention for PD, the majority expressed interest, especially in the case of a music stimulation study, in which they could carry out the activities independently at home (e.g. listening to pre-selected music). Most of the participants, whether they already use music to help with the symptoms of PD or not, displayed interest in education about the possible effects of music (e.g. in the form of a lecture), and most of them showed interest in practical workshops on the use of music. Accordingly, we planned a pilot workshop of musical improvisation, led by artist and musician Jaka Škapin, in cooperation with Trepetlika.

## Conclusion

The B-AIR project addressed the question of how to present and implement the use of music as an important factor in the Slovenian healthcare system. A pilot survey among musically active physicians confirmed the need of focusing more attention to music, as it showed a lack of knowledge and systematic education about the positive effects of music. The survey also guided our further objectives: it is essential that initiatives are not only based on the literature but also on the needs and possibilities seen by health professionals and the patients. The clinicians who completed the questionnaire felt that a trial period would be needed for the introduction of music. The following activities were aimed at setting up the foundations for a better and more widespread integration of music in medicine. In addition to continuing the current activities, which are mainly aimed at opening up the conversation on this topic (organising seminars, presentations at conferences, assemblies

and working group meetings), it is also important to start creating the conditions for musical activity in the medical facilities – which was also identified as a potential problem by the musically active doctors in our survey. Music is already used to some extent, but not systematically.

We further explored the perspective on the patients, namely patients with Parkinson's disease, on the use of music in healthcare. These are the group most directly interested in the interventions, fortunately already well organised as a humanitarian NGO Trepetlika. Half of the participants reported they already use music to help alleviate symptoms of the disease. In the other half, most of the participants expressed interest in using music for the same purpose. Most of the participants expressed interest in taking part in a follow-up study of music interventions for Parkinson's disease. Altogether these results indicate a general interest in the use of music. We also asked the participants if they ever encountered music in Slovenian healthcare. The conclusion was essentially the same as with the group of doctors – music is rarely used in the healthcare system, most of the complementary activities for Parkinson's disease patients are offered by Trepetlika. Further groups where musical interventions are expected to be well accepted and effective, include people with cerebrovascular accidents and mental disorders (e.g. dementia).

As reported by Breanna A. Polascik et al. (2020), the acceptance of music interventions requires time and education. Thus, we tried to start this process through a gradual introduction and further communication through the mass media and in professional circles, and we hope that music will gradually take on a more prominent role in the Slovenian healthcare system.

<figure><img src="image_450.png" /></figure>
Sources and literature

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Blood, A. J., & Zatorre, R. J. (2001). Intensely pleasurable responses to music correlate with activity in brain regions implicated in reward and emotion. *Proceedings of the National Academy of Sciences, 98*(20), 11818–11823.

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RADIO
TELEVIZIJA
SLOVENIJA

# MUSIC IN WORK WITH CHILDREN WITH AUTISM
# INNOVATIVE APPROACHES TO TEACHING MUSIC TO CHILDREN WITH AUTISM SPECTRUM DISORDERS

Although in Slovenia the music education system is at a high level, the inclusion of neurodivergent children is still a rather unregulated area, and there is a lack of professional support and literature to help teachers teach music to children with autism spectrum disorders (ASD). Music pedagogy for children with ASD is still in its infancy. There are records of some pedagogical methods that are claimed to be successful and useful, but as some ASDs are not yet fully understood, the area of developing adapted methods and tools for the music pedagogical process of children with ASD is also a work in progress.

One of the authors of this article, Katarina Kurtjak, teaches piano, singing and music theory. Through teaching at a private music school, she has also worked with children who, due to special educational needs and referrals, could not be enrolled in a public music school, or who lived too far away from a school that could offer them an appropriate programme. Katarina has been teaching neurodivergent children for 12 years and reports on her process: "I encountered teaching children with ASD without the necessary knowledge and training in inclusive pedagogy, so in most cases I followed my gut feeling and reacted to children. Before I started to delve into specific approaches

to teaching music, I wanted to understand what autism spectrum disorders are and how and which ones are expressed in the pupil."

According to the Diagnostic and Statistical Manual of Mental Disorders (Diagnostic and Statistical Manual of Mental Disorders, 5th edition; DSM-5; American Psychiatric Association, 2013), autism spectrum disorder is characterised by four main features, namely deficits in social interaction, deficits in communication, changes in sensitivity to sensory stimuli (light, sound, smell or touch), and restricted repetitive patterns of behaviour, interests or activities. The latter may be manifested in rigidity in interest, movement or routine, or ritualised behaviours. Meanwhile, deficits in social interaction and communication may manifest themselves in difficulties in language development, understanding imagery, socio-emotional reciprocity, non-verbal communication or establishing social relationships. In addition to these characteristics, above-average abilities are common, specifically in music processing. Individuals with ASD often present better memory for pitch and better ability for recognition of changes in pitch or identification of tones within chords, compared to neurotypical individuals (Applewhite et al., 2022).

ASDs involve a wide range of behavioural and social challenges, which can vary between individuals. Understanding these challenges is key to tailoring music teaching methods and tools to individual children. Each child with ASD is unique, and it is important to adapt teaching methods according to the specific needs of each individual. "I did a lot of reading and training, but what helped me the most was observation, talking openly with the parents of the pupils and research based on creativity and following the pupil. When possible, it is helpful to network and collaborate." reports Katarina. Collaboration between teachers, parents and possibly therapists is crucial. Together they can help define the goals and strategies that will enable the individual child to learn and develop optimally through music education.

Katarina observes, "In my experience, parents usually want to involve their child in the music education process because they themselves have noticed the child's interest, the impact of music on the child's well-being, behaviour, coping with daily challenges and stress. Sometimes it was the advice and experience of other parents that led them to music, other times therapists and teachers from adapted schools."

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In most cases, the music teacher is with the child only once a week for a short time (the 30 to 90 minutes), which is not enough to see the breadth and quality of certain approaches and their impact on the pupil. This is why the collaboration between parents and educators is so valuable and important.

## Goals

Research within teaching began due to the lack of literature and didactic tools for music teaching for neurodivergent children. Katarina: "By now there is more literature, but at the beginning of my music-teaching career there was very little. There were practically no or very few trainings and seminars."

The main aim of the research was to identify which pedagogical approaches and methods are the most useful for teaching and musical inclusion of children with ASD, specifically for piano playing in children with ASD.

Secondary objectives were also: 1) to identify and present new ways of communicating with children through music that would simultaneously have a positive impact on their well-being, cognitive, motor and socio-emotional skills; 2) to observe the progress and improve the quality of lessons; and 3) to find new ways of recording and demonstrating the progress in the above mentioned areas of children with ASD involved in music activities. The lessons themselves were not so much focused on mastery of the instrument and theory as on using musical engagement to improve the child's well-being and personal development.

Based on the objectives, the following research questions were developed:

**RQ 1:** What kind of communication has proved to be successful and with which children?

**RQ 2:** What routines and patterns can be generated to make piano lessons enjoyable and the environment safe and comfortable for children with ASD?

**RQ 3:** Which didactic aids were the most engaging?

**RQ 4:** Which methods and didactic approaches turned out to be most useful for the child's progress?

**RQ 5:** What helped the advancement of social and communication skills?

**RQ 6:** Which abilities were strengthened?

## Methods

The research is partly based on action research using multiple case studies and partly based on an analysis of diary entries from previous years.

Through the case studies, we aimed to document and describe the daily experiences and experiences of the participants (Sagadin, 2004). The further analysis of the diary entries of the past years provided a broader sample for the search of the most effective approaches, methods and tools for teaching piano to children with ASD. The latter has led to a wide variety of practical examples of the use of innovative didactic aids for the purpose of teaching children with ASD.

## Observational methods

For the purpose of the case study of three pupils, observational protocols were used. They allowed for systematic observation and determination of which methods, approaches and aids were useful in the pedagogical processes, which were not, and how this was reflected in the child's behaviour, participation, and progress.

The lesson observation chart included the following categories: method used in the lesson (e.g. "rainbow piano", visual cards, number marking of notes, listening, imitation, singing, improvisation, etc.); participation (participated, partially participated, needed encouragement, did not participate); reactions (happy, angry, unresponsive, restless, relaxed, scared, other); interests and strengths (musicality, good ear, sense of rhythm, genre of music, other).

The progress observation chart tracked five different areas of the individual's domain: adaptation to the novelties in the environment, communication, memory of musical material, concentration and attention, and freedom of expression. Each area was rated numerically from 1 to 5, where 1 indicates the individual's weak domain, 3 indicates neither weak nor strong, and 5 indicates the individual's strong domain or progress in that domain. If there have been changes in the observed domain during the lesson, a comment has been added to the change in the rating. Katarina notes the usefulness of the rating scales: "They helped me to record observations quickly, unobtrusively and uniformly, and to later assess progress more easily on the basis of all the data collected, without distracting or interfering with the learning process itself. It was important to observe the student's behaviour, to note down all the little details that would help me understand their experience of the world."

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The student's domains of strength and ability, his interests, his leisure activities, what calms them down and what triggers them were assessed. Outstanding reactions to the teacher's actions (a word of endearment, instruction, tone, gesture, advice, etc.) were recorded. "In addition to guiding the children during our lessons and trying to teach them music theory and practise like everyone else, I was especially careful in observing and recording their progress and behaviour, and using this information to develop new methods tailored to each child's individual strengths and interests."

## Diary logs

In order to provide a better comparison and insight into the usefulness of the different methods and tools, we also analysed the musical progress of 13 different students over the last 12 years of teaching, logged in the diaries. For each lesson we had the following data: the course, the methods used (how it worked, what was useful, what was not, how the child responded), the child's behaviour, responsiveness, progress and changes observed. Parents' observations and statements were also collected, in the form of notes and comments.

## Audio recordings

From January 2023, lessons with three pupils were audiotaped, resulting in three different pieces of music produced through the pedagogical process. The works are the result of adapting pedagogical methods and recording new musical material for learning. Finally, each piece of music is a reflection of a personal communication with the pupil through the medium of music.

## Participants

At the time of the research, the first participant is seventeen years old and attends a school with an adapted programme. His diagnosis is Asperger's syndrome, ADHD, dyslexia and conduct disorder. He has been taking piano lessons since the age of six, and for the last eight years at Katarina's private music school. He has an absolute pitch and an extraordinary visual memory, which are his strongest areas and great strengths in learning music. He has difficulties in reading and following music and does not understand music theory, although he uses it perfectly. He also has difficulties with concentration and attention.

The second participant is 13 years old at the time of the survey. He attends a specialised primary school. He has been singing and taking piano lessons in a private music school for five years. His diagnosis is autism with mild intellectual disability, obsessive-compulsive disorder, and speech and expression disorder. He has a very good ear and loves to perform. These are two of his strong points. He has difficulties with motor skills and taking instructions. He likes to listen to classical music and to sing along. He loves English phrases and likes to sing Slovenian folk songs.

The third participant is 13 years old at the time of the survey. She attends a specialised primary school. She has been taking piano lessons in a private music school for the last two years. Her diagnosis is autism, with associated anxiety, depression, speech and expression disorder and dysgraphia. She loves listening to music, communicating and expressing herself through music.

## Results

Through addressing research questions, patterns of effective teaching and the positive effects of music were revealed, while innovative teaching methods were defined that proved to be effective for children with ASD.

### RQ 1: What kind of communication has proved to be successful and with which children?

1. It has proved crucial to establish a **clear and personalised way of communicating**. In particular, clear and succinct instructions are important.

2. The use of **visual aids** such as pictures, symbols or communication boards can help children to better understand instructions and express their thoughts.

3. **Using alternative communication methods:** Some children with ASD have difficulties with communication. In such cases, it is useful to explore alternative communication methods such as thumbnails or electronic devices that allow the expression of wants and needs. Especially for non-verbal children, it has been shown that music itself can serve as a way to express oneself, to communicate. With one pupil, communication ran only through music, mostly through the piano, but also through rhythms played on percussion instruments or simply on the table. With some pupils it was necessary to use audiovisual aids, for example a recording of each hand separately over the piano, to serve them for rehearsal at home. With one of the pupils, the communication was done via an electronic tablet: through sounds, pictures, short clips, the program Painter.

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## RQ 2: What routines and patterns can be generated to make piano lessons enjoyable and the environment safe and comfortable for children with ASD?

1. **Individualised approaches:** every child with ASD is unique, so it is crucial to use individualised approaches to music teaching, tailoring the curriculum to the individual student. This involves thoroughly assessing the child's interest in music, their areas of strength and challenges, and adapting the curriculum according to the information gathered. Individualisation allows for better integration of the child and encourages their progress. For example, if a child has a knack for rhythm, the focus of music lessons can be directed towards this area. This approach has proved to be effective for all pupils, as it responds to the pupil's abilities and emphasises their positive skills.

2. **The emphasis on structure** is an approach that has proved effective for most students. Children with ASD often respond positively to structure and routines, which is why it is very useful to establish clear structure and routines in music lessons, both in the objectives and the flow of the lesson itself. Clearly defined steps that are repeated help children to understand what is expected of them and reduce feelings of uncertainty. For example, visual cards come in handy for understanding the flow of the lesson (see below: *Using visual aids*), or simply a whiteboard and marker pen where the lesson plan is written out at the beginning of each lesson and then crossed out and indicated where on the lesson timeline the pupil is positioned.

The latter approach has proven to be very effective with both verbal and non-verbal learners with ASD. Children with ASD often face challenges in

accepting change and adapting to new situations. The latter approach allows them to be more independent and comfortable. A clear structure of space and time has proven positive for all pupils with ASD (including those with comorbid ADD, ADHD, conduct disorder, classic autism).

## RQ 3: Which didactic aids were the most engaging?

1. **The 'Rainbow Piano':** Katarina explains the development of this method: "Coming from a classical education background, where musical notation is an important part of the transmission of musical information and knowledge, I naturally wanted to bring it closer to ASD students. I did this by first colouring the individual notes with a certain colour."

Sometimes the pupil and I chose the colour (this worked well with verbal pupils, so the colour of the note felt closer to the pupil), and sometimes I chose it myself. At the beginning I just used colour markers or crayons to go over the music, but later (when I was already adapting the music and discovered that it was possible) I created a coloured music notation in Sibelius. Then I marked the keys of the corresponding notes on the piano with the same colours. For the latter, I used sticky notes or coloured paper with adhesive tape. The pupils then played the pieces in rhythm according to the coloured music notation."

For some pupils, the method was not effective. In Katarina's group, non-verbal learners, students with speech disorders and students with intellectual disabilities were not able to follow the approach.

However, the method has proved to be very useful for verbal learners. Students with attention deficit disorders found it easier to concentrate with the colours, and the method presented a structure that was closer to them and easier to follow than the notes. It also helped pupils with Asperger's syndrome, classic autism and dyslexia. The approach was useful with pre-school children. With some pupils later adding letters to indicate certain tones helped the pupils also learn the basics of music theory. The latter has also proved successful with pupils with Asperger's syndrome, classic autism, dyslexia, attention deficit disorder and ADHD (attention deficit hyperactivity disorder).

Pumlad

<figure><img src="image_456.png" /></figure>

A. Vivaldi
priz. K. Kartjak

<figure><img src="image_457.png" /><figcaption>A coloured music notation</figcaption></figure>

<figure><img src="image_458.png" /><figcaption>The 'Rainbow Piano'</figcaption></figure>

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Often, reciting or singing notes accompanied by playing worked well. For the student with dyspraxia (poorer motor skills, coordination), the approach of marking the notes with numbers, and marking the number on the fingers with coloured rubber bands, proved to be more effective (see below: *Using sensory approaches*).

2. **Using visual aids** such as pictures, symbols or communication boards can help children better understand instructions and express their thoughts. The method can be adapted to the individual, which has proved to be very effective for most children with ASD. It has been found that children with ASD often respond well to visual stimuli, which led to development of methods such as colouring notes and keys and making visual charts, which can be used for learning notes, for improvisation and, last but not least, for following instructions and lesson planning. For example, visual symbols were used to teach rhythm, showing different rhythmic patterns. The use of picture cards showing how the lesson will proceed - visual cards - has also proved very useful. E.g. a picture of an ear for listening, a picture of a coloured piano for improvising, a picture of the sun and a smiley face for learning a new song, etc. Most of the pupils with a variety of ASDs found the visual cards made it easier to follow the lesson, follow the instructions and to concentrate on the learning process (attention span increased).

The visual cards were also used for improvisation, where the pupil and the teacher compose a piece of music together through a sequence of different images, making music together, communicating through the music. Students were encouraged to try to be innovative. Starting from a theme and a sequence of images that served as a structure for a free story, the

pupils created music. Katarina reports: "Through the visual cards, the non-verbal girl and I also made contact, through which we then communicated through the music. When she came to the lesson, I showed her a card with a question mark on it, and before that I asked her several times what day she had. In response, she would play a melody or rhythm on the lid of the piano to tell me how she was feeling."

3. **Using sensory approaches:** Children with ASD often show increased sensitivity to sensory stimuli. When teaching music, this area can be enhanced by incorporating different sensory elements such as different sounds,

touch and movement to music. These methods can be used to increase the child's interest and engagement, especially for children with ADHD, other attention deficit disorders, dysgraphia, dyspraxia. For children with Asperger's Syndrome, we can also strengthen sensory integration, which is mostly dysfunctional in children with Asperger's Syndrome.

<figure><img src="image_460.png" /><figcaption>The use of visual cards for overviewing the lesson course</figcaption></figure>

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The use of coloured rubber bands (visual and sensory approach)

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Marking the notes with colours and numbers

4. **Using sensory approaches:** Children with ASD often show increased sensitivity to sensory stimuli. When teaching music, this area can be enhanced by incorporating different sensory elements such as different sounds, touch and movement to music. These methods can be used to increase the child's interest and engagement. Especially in children with ADHD, other attention deficit disorders, dysgraphia, dyspraxia. For children with Asperger's Syndrome, we can also strengthen sensory integration, which is mostly dysfunctional in children with Asperger's Syndrome.

**RQ 4: Which methods and didactic approaches turned out to be most useful for the child's progress?**

1. **Using positive reinforcement:** Praise and rewards can help a child with ASD to associate musical success with positive experiences. This encourages confidence and a desire to progress. Stamps, stickers, cards and, for major achievements, medals and diplomas have been used.

2. **Incorporating the child's interests:** by incorporating the musical interests we can encourage their participation and motivation. If the child is enthusiastic about a particular instrument or song, this can become a central part of the curriculum. Katarina: "Here, for example, one of the pupils and I started playing popular music after a while, and eventually we started arranging and producing our own music, which he was particularly interested in. With one pupil we only learnt accompaniments to sing along to, as she was interested in accompanying herself while singing. Another pupil loved folk music, so we concentrated on that area."

3. **Working with parents and therapists** is important because it can help us get a broader picture of the individual more quickly. At the same time, in this way, the positive effects are not only contained within the lesson, but can be transferred to the student's everyday life.

4. **Improvisation** has proved to be the biggest challenge, for both the teacher and the student have to get out of their comfort zone. However, it still proved to be the most useful method of working with children with ASD, because they also became more flexible and open to everyday situations. Constancy and routine are rare in everyday life, which is full of change and unpredictable situations, so learning to be flexible and to 'improvise' is the best remedy against anxiety and stress. Of course, when it comes to musical improvisation, it is necessary to start gradually and to begin with some structure and rules. "Myself, I did it by setting a theme at the beginning, a melody, which we then played in different ways, in different tonalities, articulations, etc.", Katarina describes the process. Gradually, as much freedom and space as possible can be left for self-expression.

**RQ 5: What helped the advancement of social and communication skills?**

1. **Integrating social interactions:** Music lessons can serve as a safe environment to promote social interactions between children with ASD and their peers. Group music making, games and joint performances can contribute to the development of social skills and cooperation. Children with ASD have deficits in social communication and social interaction.

<figure><img src="image_464.png" /></figure>
In Katarina's words: "The joint music lessons and performances I organise a few times a year are very useful in strengthening and developing social skills. The children loved to participate and show each other what they could do. Interestingly, the approach also worked for the non-verbal girl who, although it took her a little longer to participate in the joint lesson, after the first joint lesson showed excitement about each subsequent one and was happy to perform. Unfortunately, this approach could not be used with a girl who was physically handicapped, extremely reserved, anxious and depressed. For a while she even wanted me to stand behind the door and look away while she was playing. Now, at least in front of me and her parents, she plays without restraint."

## RQ 6: Which abilities were strengthened?

1. Through music, it was possible to stimulate communication, imagination, flexible thinking... for example by singing, playing instruments or composing. Katarina: "As an example of personal progress, one pupil and I chose a song, listened to it, analysed it, linked it to another popular song that was similar to it, and I made an arrangement at home, which the pupil then learnt very quickly. We also did a medley of popular songs together. This involved the pupil selecting the songs and using music production software to combine them as he saw fit, to his heart's content, the individual parts of the different songs into a whole. He presented the piece to me, I wrote out the score, through which (and mainly by listening and recording his hands on the keyboard to rehearse at home) we learned the piece, and then recorded a tutorial for his YouTube channel. For the last act we used the Synthesia video creator."

2. The children with Asperger's Syndrome responded very well to the structuring with visual cards, as it was easier for them to concentrate on each step, and this showed very good results, which later helped motivate them to transfer their knowledge and skills to other areas of their lives. One of the pupils learned to read, another to write his own compositions, and a third took up music production.

3. Interestingly, all the children with ASD who have been learning music for a longer period of time and who have been involved in music have shown positive effects in many areas of their lives. All the children have shown progress in their social skills, communication and interaction with others. "A pupil, who barely spoke in the first year, avoiding eye contact and other social interactions, today sometimes discusses music, music production, events in his life with me for an hour. He has become empathetic and also open to others, he interacts more easily with other students, greets them when they come to class, asks how they are, etc." reports Katarina. This pupil, like most of pupils, has gained self-confidence, independence and adaptability to unfamiliar situations. They are coping better with stress and managing anxiety. The positive effects of music are also felt in sustained attention and severance. Children find it easier to focus on a given situation and to concentrate. Motor skills and coordination have improved in the case of the dyspraxic pupil. Katarina: "Now she can play songs with both hands at once and sing along. At the beginning of our musical journey, this seemed almost impossible. For a girl with a speech and expression disorder, her speech development has also accelerated, and today she can read simpler lyrics and sing." Most students

have developed performance skills, severance, discipline and prolonged concentration in other areas, and are much better able to adapt to different situations. The non-verbal pupil has connected with her parents through music, which has become her means of communication. For some, there was a development of flexibility of thinking, imagination and openness to the unknown, the non-repetitive.

## Discussion

The report presents some guidelines for fruitful musical engagement with children with ASD. Our analysis of piano lessons, children's responses to music and the challenges they faced clearly shows that adaptations to classical approaches to music learning can significantly enhance the experience and support the specific needs of these individuals.

## Communication and social skills

One of the key findings is that musical engagement can be an excellent environment for developing social skills. Despite the reduced perception of linguistic and social auditory stimuli in children with ASD compared to neurotypical children, it has been observed that they have a highly developed sensitivity to musical stimuli (Kim et al., 2009). These children often prefer music over verbal material and use it to meet their cognitive, emotional and social needs (Applewhite et al., 2022). It is interesting to note that despite difficulties in interpreting the spoken word, children with ASD have no difficulty in identifying and understanding the emotional, communicative and social aspects of music (Applewhite et al., 2022). For socialisation to develop, it is crucial to first establish successful communication within the music activity, which

<figure><img src="image_465.png" /></figure>
requires a clear and tailored approach. The current research demonstrates beyond doubt that this is possible, and furthermore that communication can be tailored to the individual, helping them to understand instructions and express their thoughts. We have mentioned various examples of alternative communication methods: visual aids, audio-visual aids and even music itself.

Communication difficulties in children with ASD can be linked to impaired neural connections that are crucial for verbal and social communication skills (Aithal, 2020). This may explain the observation of less frequent spontaneous initiations to interact (Kim et al., 2009). To understand how music can provide a space for communication and improve social skills, we first need to understand what everyday communication entails.

Communication can be something easy and automatic for neurotypical populations. Automatically, our attention is drawn to facial expressions, changes in intonation and other indications of our interaction partner emotions and thoughts. We synchronise with and respond to our interaction partner while maintaining a separate sense of self - how do I differentiate or relate to my partner, what is my role in this interaction? Very subtly, there is a transition which occurs more explicitly in musical engagement: first I 'hear myself', then I 'observe the environment', and then we 'experience together' (Aithal, 2020). If the teacher approaches the lesson with an interest in who the child is that they are teaching, they can allow the child to hear themselves - to play to the best of their ability, to express themselves through music, to observe themselves. Only when the child is comfortable in their own expression and is empowered by being able to hear and express himself, can the child observe the environment at the same time: "someone is listening to me, I am heard", or in

the case of communication through visual aids, "I see a picture and I show my own understanding of it", and so on. In the end, we can experience music together: "I can talk about music with the teacher, or I can show her how I hear music in a similar or different way to her" or even "we play, we feel music together". This requires a kind of interpersonal attunement, which is the last aspect of successful social communication.

If I tune in with another, I can experience the other, respond to them and start the interaction. Early mother-infant interactions are a good example of emotional, musical and motor attunement, and in infants with ASD we often see less reciprocity in these interactions (Kim et al., 2009). Because there is less reciprocity or attunement, music may represent a facilitated, more explicit (due to its structured nature) development of attunement skills that can be carried over into everyday communication.

This is reflected in the positive response to events such as performances and music lessons, which have proved to be a safe environment to practise connecting with peers, in a way that is different from the neurotypical, but no less gratifying and important for mental health.

Improvisation plays an important role in encouraging and transferring skills from musical pursuits to everyday life. As the report shows, this is one of the most strenuous didactic processes, but also one of the most fruitful ones. Improvisation has two vital characteristics: 1) it is very important in social interactions, as we have to respond to many different and new individuals in flexible ways and 2) it confronts us with not being able to anticipate everything. Improvisation allows us to adapt to unexpected social (and other) situations. In improvisational music therapy, experiencing and developing affective skills in

a social context is facilitated because of exercising attunement within the temporal structuring that is inherent to music (Kim et al., 2009).

## Structuring and individualisation

An essential characteristic of music is temporal structuring, rhythm and percussion being the two main components. In addition, the need for structure is also reflected in our understanding of tone, chord and scale. These characteristics of music are important because they are both supportive and flexible. We can lean on the rhythmic structure, if that is the child's forte, and be flexible in changing the key, or vice versa, if the child is more musical than rhythmical. If we are overwhelmed by stimuli or need more explicit patterns and rules, structuring is a good support for making changes. As we saw, if more things were clear and had an explicit structure (through visual cards and other visual aids), children were able to focus their attention more easily, were more responsive to the tasks given, understood better and followed more easily.

Children with ASD need predictability and consistent responses in order to achieve shared attention and social engagement (Kim et al., 2009). Therefore, music is an ideal environment: it allows for predictability in timing and consistent responses or structure from the teacher, while being a vivid, affective and social experience in itself.

Within the structured lessons and within the characteristics of the music, children can thus more easily become accustomed to responding to and understanding social timing and develop those skills that would require more effort in less structured and enjoyable environments.

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Sources and literature

Aithal S. (2022). * Dance Movement Psychotherapy for the Wellbeing of Children on the Autism Spectrum and their Caregivers: A Mixed-Methods Study* [Doctoral Thesis, Edge Hill University]. https://research.edgehill.ac.uk/en/studentThesis/dance-movement-psychotherapy-for-the-wellbeing-of-children-on-the

Applewhite, B., Cankaya, Z., Heiderscheit, A., & Him-
merich, H. (2022). A Systematic Review of Scientific
Studies on the Effects of Music in People with or at Risk
for Autism Spectrum Disorder. *International Journal of
Environmental Research and Public Health*, 19(9), Arti-
cle 5150. https://doi.org/10.3390/ijerph19095150

American Psychiatric Association. (2013). *Diagnostic and statistical manual of mental disorders* (5th ed.). American Psychiatric Publishing, Inc.

Hannah, L. (2009). *Učenje mlajših otrok z motnjami avtističnega spektra*. Center društva za avtizem.

Heaton, P. (2003). Pitch memory, labelling and disem-
bedding in autism. *Journal of Child Psychology and Psy-
chiatry, 44*(4), 543–551. https://doi.org/10.1111/1469-7610.00143

Jurišić, B. (2016). *Otroci z avtizmom*. Izobraževalni center PIKA, Center Janeza Levca.

Kim, J., Wigram, T., & Gold, C. (2009). Emotional, motiva-
tional and interpersonal responsiveness of children with
autism in improvisational music therapy. *Autism, 13*(4),
389–409. https://doi.org/10.1177/1362361309105660

Marčun, A. (2016). Poučevanje učencev s posebnimi potrebami v glasbenih šolah – nekatere metode in ob-like pedagoškega dela. Glasbenopedagoški zbornik Akademije za glasbo, 25, 273–291.

Piber, N. (2016). *Avtizem in glasba* [Diplomska naloga]. Univerza v Ljubljani, Akademija za glasbo.

Ockelford, A. (2013). *Music, language and autism*. Jes-
sica Kingsley Publishers.

Sagadin, J. (2004). Tipi in vloga študij primerov v pedagoškem raziskovanju. *Sodobna pedagogika*, 55(4), 88–100.

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# REFLECTION ON THE ARTWORK “FACES OF AUTISM”:
Creating and teaching music to children with ASD

As part of the B-AIR project, the artwork “Faces of autism” was also created, which through recordings of the pedagogical process, comments and statements of children’s parents, experts and students, as well as recordings of the creation of three original works, takes us into a deep reflection on music, autism and the process of music creation and education of children with autism spectrum disorders (ASD).

The radio essay intertwines different parts of the creative musical process of three different compositions, which represent the foundation of the research process, and at the same time, the compositions change through the research process itself, as they include the interests, reactions and also the creative traces of the students who perform them. The artwork aims to present the importance of musical creation, connecting and engaging children with ASD. Through experience, theory, thoughts and recordings of completed compositions, it wishes to present the adaptation of teaching methods, tools and, last but not least, the positive effects of the musical process itself.

As an author and teacher, I wanted to connect the creative and research process itself and find out how to get even closer to students with ASD, adjust the learning process itself and encourage the students to create their own works. For the purpose of

the research, I wrote three different pieces of music for three completely different students with ASD. I wrote the musical pieces based on my already existing knowledge of the students, their interests and strong domains. I wanted the initial compositions to be just a tool for learning as well as for the creation of the final piece of music, which would be made together with the students. I also recorded the initial forms of the compositions in sound and writing (audio and sheet music), and I made notes, commented on and archived each change.

The idea was that teaching methods, the meaning of music through the eyes of students, and also the connection between the research, the pedagogical and the creative process, would be reflected through the compositions. I also recorded our piano lessons for the purpose of research and artistic process itself, so I was able to include in the final art work the step-by-step creative process and the process of adapting and developing teaching methods.

As a piano teacher, I had many doubts about teaching, especially what is effective and what is not. I myself have always believed that by playing the piano I can feed my soul as well as make others happy, because music is a versatile tool that heals us and connects us. Despite everything, I was frightened of piano lessons, professors,

demands and expectations for most of my education. The very methods and requirements seemed unpleasant, artificial, and caused me stress, fear and anxiety attacks. When I myself started teaching, I was often afraid that I would ‘break it’ somewhere. I wanted the students to reach their maximum level of knowledge, progress at their own pace, and at the same time enjoy music and gladly return to it. That’s why I wanted to include in the artwork my experiences and thoughts which I hope to claim that many teachers will share.

I have learned from experience that with empathy, mutual respect and adapting the teaching methods to students, we can achieve much more than just with strictness and the uniform requirements and approaches to everyone. During my more than a decade long journey, I also faced the questions of who and what to turn to for help. When teaching children with ASD, I was often faced with the dilemma of how to approach a child, establish communication, adjust the learning process. There was practically no professional support and literature in this area, and we rarely talked about this topic at trainings and studies. At this point, the artwork through comments and examples also opens up the important question of how to improve the inclusion of children with developmental disabilities in music education and how to develop the adapted

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teaching methods. Parents' statements and music the students play reflect the importance and influence of music on the quality of life of children with ASD.

The musical excerpts are connected by comments and dialogues of female researchers in the B-AIR project – me as a piano teacher and Manca as a psychologist. My colleague Manca Kok supports the responses and listening examples with a theoretical explanation, which is also helpful to me during the process of creating research and musical work. During the process itself, she guides me with her knowledge and supports experiential examples with her expertise. In the artwork, she also explains the specifics of autism, which is crucial to understanding how to approach children with ASD. She emphasizes the diversity and uniqueness of each individual with ASD and the need for individual approach. She highlights how art and music can serve as powerful tools for connection and expression, which is especially important for children with ASD who may have difficulty expressing themselves in other ways.

The artwork "Faces of Autism" connects three different pieces of music, which reflect the different needs, adaptations, experiences and interests of three students with ASD. The first one is entitled "Along the path of the rainbow" and contains a cycle of three songs for piano and voice, which I created myself, and through the learning process adapted them to the students' needs, interests, responses and strong domains. Through the songs, I wanted to present the 'rainbow piano' teaching method, where the student and I determined a colour for each tone and learned the basic form of the composition with the help of colour notation. We then adapted the melody to the text that we sang to make it easier to remember the melodic and

harmonic structure of the music, and at the same time we wanted to highlight the student's strong domains: good listening, musicality and verbal memory, and the joy of singing.

The cycle comprises three compositions about spring, joy, colours and the warmth that invites us to nature. The student loves nature, observes its changes and also expresses his feelings through colours and natural phenomena. The sun, rainbow, spring and spring colours evoke joy, peace and warmth in him. In the first track he plays and sings alone, the second contains my accompaniment, while in the third we both sing and play and complement each other. Creating and listening together has been shown to be very effective in advancing understanding of rhythm, song structure, and sequence memorization. Through playing music together, the student gained concentration, better attention and breadth of expression. He learned how to cooperate with another person and also improved his communication and social skills.

The second piece of the artwork, titled "Gen Z Childhood Compilation", was created in collaboration with another student. Since I noticed that the student at home likes to separate and assemble individual parts of popular compositions in his own way and put them into a new whole, I wanted him to transfer this way of working to the piano and learn to play a composition that he himself composed and co-created. It is a mix of various popular songs written in an adaptation according to the student's interests, needs and previous knowledge. At the beginning, I proposed the songs myself and combined and adapted them in my own way. Through the creative process, the student added his own sequence of compositions, for which we also created and wrote down the accompaniment in the left hand and learned to play it.

Several methods and tools were included in the process. We learned how to use Sibelius and Logic pro, and for the creative and learning process we also used visual cards, which helped to improve the effectiveness of the lessons, as they showed a clear timeline of the lesson and a structured schedule that provided the student with additional support in following and understanding the lesson process and the instructions. Through the very process of creating joint work, the student and I got to know each other even better, connected and created a pleasant atmosphere in the classes, which we both enjoyed going to. The student's statement is also added to the work, explaining further his experience and the very concept of the musical work.

The third piece is titled "Ana's world of dreams" and it shows the course of guided improvisation – the development of improvisation from the initial lessons which were almost entirely guided, to the final product, where the students' progress in independent expression and free improvisation is shown. At the beginning, the composition consists of three different proposals for creation, which, through a few minutes of improvisation, develop into a reflection of authentic communication between the student and the teacher through music. You can hear joy, relaxation, connection and progress from lesson to lesson, recording to recording.

In the artistic and research process I myself learned what power music has in connecting, learning and getting to know oneself and one's feelings. The artwork shows us ways and examples of how music can become a bridge for connecting and expressing ourselves, regardless of individual challenges. It turns out that some teaching methods can be effective for most students, but not in all periods of their life

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and personal development. On the basis of examples, comments and statements, we can conclude that it is necessary to constantly adapt both teaching methods and the requirements and goals of the curriculum. If we want to achieve maximum development in the student, we must also develop the learning process in parallel, adapt it and make it attractive according to the student's interests. The musical works show how much children with ASD can achieve if we approach them in the right way, and also present some examples of effective methods and approaches. Through music and students' stories, we can learn about the positive effect of music on them and how it also influenced the development of other abilities. The artwork leaves room for further research and urges listeners to develop this area of music pedagogy and therapy.

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# REFLECTION ON THE RESEARCH AND ARTISTIC PROCESS

As a collaborator, coming from the field of psychology and with interest and experience in exploring the utility of music, I joined Katarina's research process in order to give more structure to the process and the product. Katarina's many years of experience were the most valuable part of the research, given the development of didactic tools and teaching skills for children who are very different from each other is a very slow and long-lasting process.

Katarina added structure to her existing diary entries with research questions, which we defined through conversation. The systematization of such material is very valuable, because only with distance it is possible to explain one teacher's intuition to another.

In order for Katarina to acquire even more methods for research work, I directed her towards action research, which is an approach aimed at improving practice in a real environment. Key features include collaboration between researchers and practitioners, a cyclical process, critical reflection, implementation of actions to solve concrete problems, changing practice based on findings and a focus on sustainable improvements. Some of these foundations of action research were already used by Katarina, but she used them even more explicitly in the last six months. This work is a product of a never ending cyclical process, grounded in the awareness that learning is part of the developmental process for every teacher.

Although structuring and preparing radio materials is a new practice for Katarina, with her effort and courage she has created wonderful contributions that will help and inspire many.

It is important to point out that many music teachers would not dare to face the challenge of teaching students who are not included in the classical education program. Coping with misunderstanding and continuous adaptation to students, requires courage and perseverance. This is evident in the results of incorporating improvisation into a process that can provoke great resistance in the learner. Courage for this process is rewarded with flourishing which shows itself in various areas, after the child has accepted improvisation and enjoys it.

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RADIO
TELEVIZIJA
SLOVENIJA

MUSIC AND
PARKINSON'S
DISEASE
Ana Kuder

Division of Neurology, Institute for Clinical Neurophysiology, UMC Ljubljana

Jaka Škapin

transdisciplinary artist, composer, vocal improviser, London, UK

Manca Kok, MSc Psychology

University of Amsterdam, the Netherlands

ana.kuder@kclj.si

jakaskapinmusic@gmail.com

manca.kok@gmail.com

# MUSICAL INTERVENTIONS FOR PATIENTS WITH PARKINSON'S DISEASE: A pilot project with a survey and a music-based improvisation workshop

## Characteristics of Parkinson's disease

Parkinson's disease (PD) is the second most common neurodegenerative disease (the first is Alzheimer's disease). In Slovenia, the estimated number of patients with PD is around 7000 (Trepetlika, 2009; Trošt, 2008). PD is a chronic, progressive neurodegenerative disease that affects the dopaminergic system in the brain (Carod-Artal et al., 2013). Dopamine is a neurotransmitter involved in movement, motivation, memory and several other functions. In PD, the loss of dopamine causes various motor and non-motor impairments (Carod-Artal et al., 2013; Emamzadeh & Surguchov, 2018). Hallmark motor symptoms are bradykinesia (slowness of movement), rest tremor (involuntary rhythmical movement at rest), muscle rigidity, and postural instability (difficulty balancing) (Nestler et al., 2015). Difficulties in the initiation of movement arise, making it challenging for the patients to perform daily tasks. Patients start and execute the movements slowly with intermittent pauses. The patient's face becomes less

expressive, and facial expressions are impoverished (Nestler et al., 2015; Trošt, 2008). Postural instability generally appears in the late stages of the disease and is one of the most debilitating symptoms of PD, as it can increase the frequency of falls and may worsen its consequences (Viseux et al., 2020). Up to 86% of patients with PD also experience freezing of gait by the late stages of the disease. Freezing of gait is described as a "brief, episodic absence or marked reduction of forward progression of feet despite the intention to walk" (Bekkers et al., 2018; Heremans et al., 2013).

Among the non-motor symptoms of PD, disturbances of the autonomic nervous system, such as constipation, incontinence, erectile dysfunction, abnormal heartbeat, dry mouth, sweating, and low blood pressure are common. Olfactory dysfunction and problems with odour recognition also occur and can in some cases even precede the motor signs of the disease. Patients may also face weight loss and various sleep disorders (i.e. REM sleep disturbances, which can also precede the motor signs) (Goetz & Kompol-

iti, 2005; Trošt, 2008). Throughout the course of the disease, various behavioural and cognitive symptoms may arise. Depression occurs in about one-third of the patients, and dementia is present in 20 to 40% (Aarsland et al., 2001). Attention, executive functions, and working memory may be significantly impaired, and problems in the ability to plan more complex tasks and multi-tasking may also appear (EPDA, 2009). Hallucinations and other psychotic symptoms occur in approximately one-quarter of those affected (Goetz & Kompoliti, 2005).

PD also includes a variety of social symptoms, which can also significantly diminish the quality of life, as the social roles get altered by interfering with employment status, household management, friendships and other relationships. Patients with PD experience disruptions in emotional expression (facial masking), recognition of others' expressions, and disruptions in emotional speech production (dysarthria) and perception (Prenger et al., 2020; Perepezko et al., 2019).

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Different medications and therapies for symptomatic treatment of PD (controlling for PD symptoms) are currently available (levodopa is the most effective one); however, no cure exists yet. In the late stages of the disease, with very severe and treatment-resistant symptoms, deep brain stimulation may be used and involves electrical stimulation of certain parts of the brain by a neurostimulator device (Emamzadeh & Surguchov, 2018). Some complementary treatment strategies have been showing effectiveness in the alleviation of some symptoms. Among the most commonly used are: physical/occupational therapy, physical exercise, dance, biofeedback, external sensory feedback, and training with virtual reality (Ghai et al., 2018).

## Why music for patients with Parkinson's disease?

Dalla Bella and colleagues (2018) state that rhythmic abilities are widespread in the general population. Most people can extract a normal rhythm from music and match their movements to the rhythm. People with PD often experience disturbances in the function of internal timing and rhythmic abilities, especially with disease progression. As rhythm is known to be closely related to movement, several studies (Devlin et al., 2019) suggest some musical and rhythmic interventions may improve some symptoms of PD, namely walking impairments, as well as some other motor and non-motor symptoms. Evidence has been accumulating that people with PD benefit especially from music with strong and clear rhythmical beats, as it likely enhances the feeling of internal timing, which can be impaired in PD. Ghai and colleagues (2018) suggested that a musical cue can serve as an external stimulus that may bypass the affected brain regions (basal ganglia), thus helping with the initiation of movement, and further increasing the

participant's speed and stride length. Nieuwboer et al. (2010) also additionally reported improvements in gait and balance. Furthermore, Jola and colleagues' (2022) study results show prolonged effects of dance interventions on gait, even after the dance class and without hearing music. The results are in line with the hypothesis that music enhances the feelings of internalized rhythm that supports motor control and improves gait even after the patients stop listening to music and are no longer dancing. Harrison and colleagues (2019) report that even quiet/mental singing (e.g., mental singing of a marching band while walking) improves motor performance in older adults and people with PD.

It is important to emphasize the neuropsychological aspect of music interventions as well. General positive feelings associated with music facilitate dopamine release through increased activity of the limbic system in the general population and can thus be effective in people with PD as well. Music-based movement interventions have repeatedly been found to improve not only motor symptoms but also cognitive functioning and life satisfaction in people with Parkinson's disease. Music and singing are thought to be beneficial as they can be used as a tool to communicate and express emotions, both of which can be difficult for people with PD. The application of music can complement or even exceed the benefits achieved through other methods of treatment (Dalla Bella et al., 2015; Morris et al., 2019).

## The patients' perspectives on the use of music

Various types of music therapy and musical interventions, such as neurological music therapy and auditory music stimulation, are already being used globally as complementary treatments

for PD (Thout & Hoemberg, 2014). In Slovenia, some forms of music and dance therapy are being used non-systematically, especially within the association of PD patients – Trepetlika. However, the existing and future efforts to ameliorate the symptoms of PD could benefit from more systematic research and quantification of these effects. We aim to fuel this research not only from existing literature but also from the needs and experiences of people with PD.

In light of the latter, we designed a questionnaire for individuals with PD with three objectives:

1. To gain a better insight into the current (personal/private) use of music to alleviate PD symptoms.

2. To evaluate current attitudes towards the use of music or musical interventions in the healthcare system for alleviating PD symptoms.

3. To assess willingness to participate in a larger study where different types of musical interventions would be targeted and their effects on PD symptoms examined.

## Participants

Eighty-seven individuals with PD were included in the study, out of which 8 individuals did not complete the minimal number of questions needed for inclusion in the analysis. Thus, the final sample consisted of 79 individuals with PD, of whom 27 (35%) were women. The average age of the participants was 68 years. The majority of the participants identified as musically inactive music lovers (70%), while 23% of the participants identified as former active musicians (23%).

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Among currently musically active individuals (5%) and a couple of professional musicians, only one-fifth reported formal music education (20%).

## Results

**Alleviation of PD symptoms:** Approximately half of the participants (49.4%) reported the use of music as a way of alleviating PD symptoms. Among the other half of participants (n = 40) who are currently not using music for this purpose, 30 (75%) believe that music could help alleviate their symptoms, and 32 (81.2%) think that the presentation of current findings on the effects of music on PD symptoms could encourage them to use music for symptom alleviation.

We then asked the participants who already use music for PD symptom alleviation, in what ways they engage with music for this purpose. The most commonly reported was passive listening of music (Figure 1A).

We then asked the participants about the type of music that is most helpful for them in alleviating PD symptoms. We did not discover any specific pattern; the choice is highly dependent on the individual taste and access to music (e.g. listening to music on the radio is less personally adaptable, compared to listening through the internet/streaming apps).

We were further interested in the resources the group of patients with PD, that do not yet use music but reported they believe music could help with the symptoms of PD, would need. The most

commonly reported needs were assistance in setting up the music, reminders for music listening and a pre-prepared playlist they could listen to (Figure 1B).

**Music in Slovenian healthcare:** In our group of participants, only 12 individuals (15%) had encountered music within the healthcare system. Most had encountered music during magnetic resonance imaging, one participant encountered music in a private dental practice, and another participated in a music therapy session within the psychiatric hospital. Though not part of the healthcare system, several individuals mentioned encountering music with the purpose of symptom alleviation within various gatherings and activities organized by the Parkinson's Disease Association of Slovenia – Trepetlika.

Figure 1: Word clouds of the most commonly reported ways of using music to alleviate PD symptoms (A) and needs to motivate the participants to use music to alleviate PD symptoms (B)

<figure><img src="image_476.png" /><figcaption>Figure 1B</figcaption></figure>

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**Current attitudes towards music implementation into the healthcare system:** The majority of the participants (n = 60; 76%) find the implementation of targeted musical activities into PD healthcare sensible and beneficial. None of the respondents felt the idea was not meaningful, but 8 individuals (10%) believed it could have both positive and negative effects. 12.7% of participants (n = 10) did not wish to express their opinion on the topic.

**Interest in participating in a larger study:** We explored the interest of the patients with PD to participate in an advanced study on the effects of music therapy on PD symptoms, where they would undergo several hours of music therapy. 72% of participants (n = 57) expressed interest, while 27.8% (n = 22) would not be willing to participate. Of these, 10 individuals expressed concerns due to transportation issues, 6 due to difficulties with accompaniment, and 3 due to lack of time. The rest of the participants did not provide reasons for not wanting to participate.

Furthermore, the patients with PD were asked if they would be willing to participate in a study on the effects of music stimulation on PD symptoms, conducted at their homes (e.g., participants would listen to specific music every day). 84.2% of participants (n = 64) expressed interest, while 15.8% (n = 12) would not want to participate in the study. Of these, 4 individuals expressed concerns due to the lack of technical equipment, 3 individuals saw difficulties in setting up technical equipment, and 3 individuals did not want to participate in the study due to lack of time. The rest of the participants did not provide reasons for not wanting to participate.

**Interest in the relationship between music and Parkinson's disease:** Finally, participants were asked what would be their main interest/activity of choice in terms of spreading information or knowledge about the connection between music and PD. Almost half of the participants expressed interest in educational lectures on the effects of music on PD symptom alleviation. Slightly fewer individuals (40%) would be interested in participating in a multiple-session workshop on the use of music for alleviating PD symptoms, while 26.7% of participants expressed interest in the Q&A session with experts in the field. 23.3% of participants were interested in a workshop on music-based improvisation, and 22.7% of participants were interested in a one-time workshop. Under the “Other” category of answers, a dance workshop was highlighted (Figure 2).

**Correlation analysis:** We explored the correlation between the willingness to attend a few hours of music therapy for the study on the effects of music on PD symptoms and several other variables. We only discovered a moderate correlation between the described willingness and the expressed interest in participating in the study of musical stimulation, which would be carried out at the patient's home. We discovered no correlation between formal musical education, previous experience with music in healthcare and current (private) use of music to alleviate symptoms of PD.

<figure><img src="image_479.png" /><figcaption>Figure 2: The expressed interest of PD patients (in %) for different activities which may help in promotion of the use of music to alleviate Parkinson's disease symptoms</figcaption></figure>

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## Conclusions

Based on the results of our study, we conclude that music already represents an important tool for alleviating PD symptoms in many individuals, while others show a significant interest in using music for this purpose in the future. Half of the respondents already use music for alleviation of PD symptoms, with most of them using it passively, mainly to help regulate their mood. Some use music to help them with movement and coordination, and a few participants use music actively, primarily through dancing or playing instruments. For those participants, who do not currently use music but would like to, there seems to be a need for pre-prepared music, reminders for listening and assistance in the music setup. Most of the participants (those who already use music and those who do not) would prefer a presentation of key findings on the benefits of the use of music in PD. In general, participants show the most interest in education, while they express less interest in Q&A sessions with a professional, working in this field, likely because they do not yet have a concrete foundation on the topic.

Regarding the interest in participation in a study on the effects of music on PD symptoms, the majority of respondents expressed interest, especially when it comes to activities that they could carry out independently at home (e.g., listening to selected music). However, it needs to be emphasized that the study mostly involved members of Trepetlika, who likely have a predisposition for such complementary activities that could help alleviate PD symptoms. Therefore, the results are likely not representative of the entire population of patients with PD. In expressing an interest in study participation, individuals are mostly limited by transportation and accompaniment, technical equipment and time. Those willing to participate in a study of music therapy

also express interest in music stimulation study, but not *vice versa*. Surprisingly, the interest in taking part in the study does not correlate with any other factor (e.g., formal music education, current use of music). The participants showed interest in the practical workshops on the use of music. However, less interest was expressed in a workshop with music-based improvisations. Improvisation may be intimidating and harder to imagine if one has never done that before.

Finally, only a small percentage of the participants have encountered the use of music in the Slovenian healthcare system. However, the opinion on the implementation of music into the healthcare system is mostly positive.

## Music-based improvisation as a form of intervention

The workshop facilitator, Jaka Škapin, considers his approach in this setting as non-therapeutic, even if it results in potential therapeutic effects. In doing so, he is following the values of the Dancing with Parkinson's programme, developed over more than a decade by Danielle Jones, artistic director of Luminelle, in London and beyond. He first joined the project in 2016.

"The Luminelle Dancing with Parkinson's programme brings expressive, moving and creative dance opportunities to people with Parkinson's, their family members and carers. It is a core programme developed by Artistic Director Danielle Jones, over 14 years of practice in this specialist health arena. Featuring live dance and live music, Luminelle's workshop programme offers people with Parkinson's the chance for personal enquiry, and artistic expression, to feel seen and experience compassionate connection with like-minded

participating dancers, both digitally in our at home programme, and in-person in our workshops and events across the UK and internationally." (Luminelle, n.d.)

Deploying these values during the pilot workshop on August 28th 2023 in Maribor, we explored the possibility of using improvisation to maintain and improve the vitality of the vocal cords as one of the body's muscles, and choreographically built physical expressiveness and mobility as a creative activity for all.

The workshop began with a short presentation of the Dancing with Parkinson's approach, as well as the introduction of the guests in the space, who all actively participated, except the sound and video crew. We then gathered in a seated circle, starting with a body scan and mindful awareness of the breath and body. Afterwards, we gently started to warm up the body through stretches that involved imagining reaching further than our seated position, into the space, towards others and outside of the building in which we were in – relating to our inner as well as outer environments. We then proceeded to individually imagine that we were moving through our homes, utilising the memory of objects and room placement to create movement patterns based on everyday habits and activities. This was the first instance when some of the participants began to stand up during their exploration.

During the whole workshop, the facilitator led through words as well as improvised vocal music captured on a digital vocal looper. While the intro and warm-up featured a meditative soundscape, he first introduced a clear groove in the before-mentioned home memory exploration,

<figure><img src="image_481.png" /></figure>
which prompted sharper movements through the speed of the music, as well as rhythmic parts that conjured up the sound of home appliances, sliding objects and so on. This created the first bank of movements, which we returned to later on. What followed was a standing duo mirroring exercise, which started with one person leading and another following, before merging into an area in between, where neither of the movers knew who was leading or following, or in essence, they were both doing so by switching the roles quicker and becoming more attuned to their partner's choices and interests.

After a break, we returned to a trio exercise, where one person was more static at least at the beginning and allowed the other two to find different configurations of dueting around their body. This was a development of the duo exercise which allowed participants to work with a new partner, as well as include some of the gestures that they developed before the break. The exploration was also supported by quick coaching moments when the facilitator went around to different groups and suggested possible developments for their emerging choreographies, themes and relations.

During the last part of our session, we expanded this setup to include everyone. The first three people in the space were static for at least the first half of the exercise, with everyone else being able to freely move between them, adding on the notion of threads that allowed them to guide their movement from one person to the other, from one side of the room to the other, imagining that different parts of their body connect different parts of the space.

What emerged at this point was also the need and want to vocalise, and sing, especially as the facilitator left the loop station and continued singing

while moving through the group. This led to a poignant closing circle where we all sang long notes, let go of the movement exploration and concluded by pressing into each others' palms, transferring weight and swaying in a closed circle.

The facilitators' experience of the group was that most of them had not had prior encounters with music-based improvisation, although they were all interested in exploring it. It felt that the gradual introduction of the 'free' movement helped, as well as the relationship between their choices and movements related to everyday life, and the relationality of being able to rely on a partner, or simply be inspired and copy anyone in the space. What was also essential to the process were the dance assistants, who were able to support participants through their embodiment and examples of movements that would not have been explored otherwise, such as how arms or upper body do not necessarily always have to lead and so on. Lastly, having even just one or two participants who have an established relationship with improvised singing and movement helped the group feel at ease, as they confidently entered explorations and helped guide the group towards present-moment awareness, and less concern around how they might be perceived, or if they might not be doing the 'right' thing. This was exemplified during our conversations after the workshop, in which many participants expressed that the open space created allowed them to move and interact in new ways, as well as build a strong sense of connection and acceptance among the group.

## Excerpts from the interviews and radio documentary

Below are excerpts from three participants' interviews captured after the session:

"When I arrived, earlier, I felt something, how should I say, anticipation, but also a little trepidation and reluctance. What will happen? But this was something incredible, it just blew me away. When it started, the intro and then the music, and the facilitation and ... I just felt good. Relaxed, I sometimes felt that we had to awaken our inner child, today I managed to do it, even though I always wondered, how? I kind of immersed myself in the music. Somehow music, when you feel it inside you, that rhythm carries you away. And I think that this is also the part that leads to the relaxation, besides of course all the other movements we performed during the music. It seems to me that in life, if you have some problems, and if you have some activity where you can relax, so that the body is relaxed, you can tolerate all these problems more easily, and you may feel them to a lesser extent. Because when you are relaxed, the physical pain is also lessened, since the muscles are relaxed and we are not so stiff as we say." - Milica Kopić

"Where you have set steps, you cannot relax. In other words, your mind works, your mind has to lead, how many steps there, how many there, here, and you think about it. But when you have such relaxation with music, and creating, then you are not burdened with something you should know, or how you will be perceived, because you know that if you let yourself go, it is always fine, it cannot be wrong or right. And this is the kind of relaxation that also relaxes your mind, that it is relaxed, that it is not burdened with certain thoughts, all day we think, now I can do this now I can do that, how will I do this, how will I do that, but here you are as if you are switched off, you switch off and you fall into yourself. The music had such an effect on me that as soon as I heard it, I couldn't wait to be in it with my body. Because when you join the music, it's that

<figure><img src="image_482.png" /></figure>
rhythm that pulls you in and makes you forget about everything else.” – Biserka Muršec

"The therapeutic exercise organised in the health care centre satisfies us from the aspect of motor skills, the increase of mobility. This workshop however offers something that physiotherapy does not. And that is the music, the bespoke music, the voice of the workshop leader, a voice that relaxes you and encourages you to try and sing something. This is related to problems that people with Parkinson's have regularly, our voice gets weaker and weaker, with the articulation of the voice worsening. Any singing that is encouraged by someone is a positive for us since we don't usually sing unless someone gets us to do it. As people, we need both movement and increased motor skills, but we also need singing and we also need music, and we also need the atmosphere that is created within the group, so that people want to come to the group to also enjoy themselves, to actually have fun, which is visible from their mood, that they are comfortable. In short, I think that even back at home, the people in the family to which the patient returns from such a workshop would be content, because they'd arrived relaxed, full of energy, and should've been sent back the following week. I would like this also as a service that would be made possible by the healthcare system, because the healthcare system should actually be the pillar that allows such non-pharmacological exercise, influences it, from a positive aspect and actually enables us to achieve additional, I would say, benefits, which we have not experienced up until now." – Vinko Kurent

## Adavantages of music-based improvisation

Whilst people with PD commonly report a calming effect while listening to music, the music listening alone does not seem to affect the subjective experience of an

improvement in their motor symptoms. A music-based movement intervention (e.g., dancing) combines the physical, rhythmical, psychological and emotional aspects, which is why it may be more effective than passive music listening. Furthermore, evidence from qualitative studies indicates that the majority of participants experience exercise dance programs as helpful with regaining a sense of positive identity, decreased feelings of isolation, better mood and quality of life, reduced motor symptoms, and enhanced functioning. In the subjective experience of motor improvement, a combination of dancing, music and signing is likely most beneficial (Jola et al., 2022).

Ashoori and colleagues (2015) have postulated that an adaptive system that adjusts the rhythm of movement is most efficient for intervention in PD, as the music is hypothesized to have a detrimental effect on motor performance if the exercise mode demands high levels of concentration. In such instances, the human brain attempts to partially suppress potential distractors to enable the organism to engage with the task. Rhythm that is too fast may thus exceed the physical abilities of the individual and induce more stress, which may lead to a higher risk of falls. This is why music-based improvisation may be of relevance and represents an added value to these interventions. First, in music-based improvisation, all three components are included – dancing (moving), music and singing. Secondly, the leader of the workshop can adapt music and rhythm to the specific group of patients, to prevent disruptive effects. During the workshop, the leader facilitates the process, but there are no right or wrong movements, so everything is allowed and each individual can execute the moves within his abilities. There are also no choreographed movements, which can put an additional strain on the memory processes in people with PD. The whole process of music-based improvisation

benefits the feeling of social connection and social involvement. It may also benefit the sense of positive identity of people with PD.

## Experiences and impressions of the participants

In the interviews, that we conducted after the music-based improvisation workshop, the participants most commonly reported feeling relaxed and more socially connected to the group and their partners (if they attended the workshop together with their partners). A lot of the participants also reported feeling calm, happy and motivated. Some of the participants felt attunement and wakefulness, as well as openness, liveliness and centrality. The participants found it beneficial that all movements were spontaneous and not pre-planned, as this allowed them to delve into themselves and follow their impulses when moving. One of the participants pointed out the pleasant surprise of the kindness of strangers, and another participant noted the workshop was a good preparation for the unknown, as no movement or activity within the workshop was precisely planned. All participants expressed interest in possible further workshops, and most of them stated they would gladly come again the following week. Most of the participants also agreed they would benefit from the possibility of pre-prepared music to which they could try the activities at home. The conclusion of the workshop was that the group is a key factor in the process, as it enhances the interest and motivation in the activities and affects the feeling of connection, which is not the same if one individual tries these activities by themselves. It is best if these activities can be tried at home with at least one more person, preferably a partner or a caregiver, as it may benefit not only the person with PD but also their relationships.

<figure><img src="image_483.png" /></figure>
## Conclusions

Some variations of music and dance interventions are already in use within the Parkinson's disease association of Slovenia – Trepetlika. However, there is a need for systematic research into the use of music for alleviating PD symptoms and quantifying the effects of music, to encourage the targeted use of music interventions within the Slovenian healthcare system. Only a small group of participants have encountered music in Slovenia healthcare system and none of them have encountered music in the context of Parkinson's disease. However, the majority of the participants expressed interest in the use of music, as well as the participation in further studies in music. Current scientific findings are essential for achieving the systematic use of music, but the experiences and needs of patients should be taken into account as well, as they are crucial for future insights and motivation for future studies.

The Dancing with Parkinson's approach introduced to Trepetlika's Maribor members was positively received and engaged participants with previous as well as no dance of group improvisation experience. The workshop provided self-expression as well as social connection space different to existing dance programmes or the physiotherapy currently provided within the public health care system. The majority of the participants saw this practice as a valuable complementary activity that they would like to explore further and experience regularly.

<figure><img src="image_484.png" /><figcaption>Illustration by Zala Kalan</figcaption></figure>

<figure><img src="image_485.png" /></figure>
Sources and literature

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Ashoori, A., Eagleman, D. M., & Janković, J. (2015). Effects of auditory rhythm and music on gait disturbances in Parkinson's disease. *Frontiers in neurology, **6***, 234.

Bekkers, E. M. J., Dijkstra, B. W., Heremans, E., Verschueren, S. M. P., Bloem, B. R., & Nieuwboer, A. (2018). Balancing between the two: Are freezing of gait and postural instability in Parkinson's disease connected? *Neuroscience & Biobehavioral Reviews, **94***, 113–125.

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Dalla Bella, S., Benoit, C. E., Farrugia, N., Schwartze, M., & Kotz, S. A. (2015). Effects of musically cued gait training in Parkinson's disease: beyond a motor benefit. *Annals of the New York Academy of Sciences, **1337**(1), 77–85.

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Jola, C., Sundström, M., & McLeod, J. (2022). Benefits of dance for Parkinson's: The music, the moves, and the company. *Plos one, **17**(11), Article e0265921.

Luminelle. (n.d.). *Dancing with Parkinson's*. https://www.luminelle.co.uk/dancing-with-parkinsons/

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RADIO

TELEVIZIJA

SLOVENIJA

HOSPITAL RADIO
## HOSPITAL RADIO

Hospital radio is created for toddlers, children and adolescents who for various medical reasons visit the hospital for a short or longer period of time. The artistic content has been carefully curated in order to make their stay in the hospital environment easier and reduce worry and tension. The artistic, entertaining, educational and other content is selected that can be calming and supportive to children during hospitalization, as well as helping them cope with, learn about, and understand what is going on during hospital stay.

The Hospital Radio is thus created together with the University Children's Hospital Ljubljana, the hospital's school and kindergarten, experts from various scientific fields, and artists and artistic organizations, all contributing their knowledge and art to the broadcast.

The proposal for the Hospital Radio concept was given by the neuropaediatrician, chief physician Igor Mihael Ravnik based on his extensive and valuable work experience and network. Radio Slovenia realized it with the cooperation of the University Children's Hospital Ljubljana management, expert director doc. dr. Marko Pokorn, dr. med., and doc. dr. Klemen Dovč from the clinical department of endocrinology, diabetes and digestive diseases.

<figure><img src="image_488.png" /><figcaption>Artworks by children from kindergartens upon listening sessions at the Festival of Radio Plays for Babies and Toddlers, RTV SLO, March 2023, Ljubljana, Slovenia. Photo by Katja Kodba</figcaption></figure>

<figure><img src="image_489.png" /></figure>
# KAJA HAS TO VISIT THE HOSPITAL
(Excerpt from a radio drama)

Nurse JANJA

Girl KAJA, a patient

Kaja's DADDY

Kaja's MOMMY

SURGEON

ANESTHESIOLOGIST

Taking place in the children's hospital.

JANJA: Good morning, Kaja! How did you sleep?

KAJA: Good. Pst, Daddy is still sleeping. (in a hushed voice) I was dreaming about My Bunny, running around on a meadow and eating grass.

JANJA: Kaja, I'm sorry but today you cannot have breakfast.

KAJA: I know, I know everything. We cannot eat before surgery.

JANJA: You will get a special syrup so you won't be scared. It's called premedication. Open your mouth.

KAJA: (slurps from the spoon) Oh, it's so sweet!

DADDY: Oh, good morning! Can I also get some of that syrup, hahaha?

KAJA: No, daddy, you can't. You have to be scared so I won't be, when I'm in surgery.

JANJA: Well, is our champion ready for a short trip?

KAJA: Oh my, we're going now? Can I take My Bunny?

JANJA: Of course! We'll go very slowly to the operating room. Come!

DADDY: I'll be with you the whole time and mommy's also coming.

*(The noise from the hallways, children's muffled singing: "When we count to five, my pain is gone bye bye 1,2,3,4,5, auuu, my pain is gone bye bye.")*

It could also be a recording of heart rhythm - du-dum, du-dum- if that's not too much?)

SURGEON: Hello, little girl, how are you? I'm the surgeon.

KAJA (calmly, after drinking the syrup): I'm Kaja, normally I go to school, and this is My Bunny, he stays at home.

SURGEON: I'll do the surgery, in the operating room next to this one. An anesthesiologist and a nurse will help me. The anesthesiologist will help you fall asleep.

DADDY: Kaja, look, mommy is here!

KAJA (happily): O, mommy, mommy!

MOMMY: I'm here! Let me hug you and kiss you. Everything will be fine.

KAJA: Will you and daddy take care of My Bunny if I sleep too long?

DADDY: We'll take care of everything. We'll wait outside, in the hallway.

SURGEON: Kaja, are you ready for a long sleep?

ANESTHESIOLOGIST: You said you go to school, Kaja. How old are you?

KAJA: I'm eight already!

ANESTHESIOLOGIST: That's a lot! And how high can you count?

KAJA: I don't know, high...

MOMMY: Tell him, Kaja, how high. You're very good with numbers.

KAJA: One, two, three, four, five....

*(Falls asleep.)*

<figure><img src="image_490.png" /></figure>
## Credits:

**Text authors:**

Janja Hana Jamnikar,
Andrej Adamek

**Adaptation author:**

Suzana Tratnik

**Director:**

Saška Rakef

**Dramaturge:**

Vilma Štritof

**Music designer:**

Darja Hlavka Godina

**Sound designer:**

Urban Gruden

## Cast:

**Kaja:** Luna Khaleesi Meglič

**Brina:** Mila Mrak

**Mom:** Sabina Kogovšek

**Dad:** Matej Puc

**Admission nurse:** Barbara Rojnik

**Janja, clinical nurse:**

Slavica Ravnik

**Doctor Breda:** Katarina Borovnik

**Surgeon:** Igor M. Ravnik

**Anesthetist:** Vladimir Bricelj

**Hospital educator:** Janja Hana Jamnikar

Recorded in the studios of Radio Slovenia in
October 2021

**Production:** B-AIR, Editorial of the Radio
Slovenia Fiction Program

<figure><img src="image_491.png" /><figcaption>Photo by Katja Kodba</figcaption></figure>

To listen to "Kaja Has to
Visit the Hospital":

<figure><img src="image_492.png" /></figure>

<figure><img src="image_493.png" /></figure>
# TESTING RADIO PLAY IN CHILDREN HOSPITALS

In the final phase of the B-AIR project (November-December 2023), RadioTeatar started to test radio plays for children in hospitals. The opportunity to share our radio plays with children in the hospital came through the collaboration with the Elementary School "Ivan Goran Kovačić" from Zagreb, whose teachers also run the school in the children's hospital "Srebrnjak".

What we found out about the school in this hospital is that the classes are always combined, similar more to individual instructions (repetitions) than

the regular classes. Having in mind the fact that the group changes every day, most of the materials need to be made for self-directed learning, and facilitated in that way. It is happening because the fluctuation of children in the hospital is quite big and fast. The children mainly spend several days in the hospital, in order to do some diagnostic appointments with doctors, and medical treatments. Besides that, sometimes they have medical tests in the 'school time' (which is usually in the middle of the day).

Music and Arts teachers usually work in the hospital once in 15 days, which means that there is a lack of artistic content in the 'curricula', comparing to the content of 'more important' subjects such as Mathematics, Croatian language, etc. where children usually have a lot of homework to do (e.g. in workbooks from schools). The groups of children in the hospital school are mixed, unpredictable and very heterogeneous: sometimes there are 5-year-old and 13-years-old children in the same group, which poses a real challenge for the teachers in deciding on the learning and teaching strategies.

<figure><img src="image_494.png" /></figure>

Ek o baraba i
petrica puh

<figure><img src="image_495.png" /></figure>

MOJ SCENARIJ ZA DJEČJU
EKO-RADIODRAMU

<figure><img src="image_496.png" /></figure>

RADIO TEATAR
BAŠIĆ & DHIATELJ
-ZAGREB-

<figure><img src="image_497.png" /></figure>