Impact case study database

The research has led to improved health and wellbeing for thousands of children and adults with physical and learning disabilities, and those experiencing mental illness or social disadvantage. The impact of the work can be found in: 1. bringing about growth, change and new collaborations in organisations that have adopted musical improvisation to help people with impairments to improve their communications skills and self-esteem in social and educational settings and 2. developing new strategies that improve gait among people with physical disabilities worldwide.

The 2018-2019 Music as Social Innovation partnership directly benefited Limelight Music, a Scottish music training and production company that specialises in high quality training and developmental opportunities for people with impairments. The partnership led to the creation of educational strategies and workshops that provided musical activities to groups often denied access to them. Limelight stated that a 20% growth in the company can be attributed to MacDonald’s involvement with the company in both strategic development and workshop design [5.1]. Limelight has been able to employ six musicians from the disabled community on a project basis, as well as provide additional work for core staff [5.1]. The project has also helped Limelight develop new partnerships with the NHS in Scotland and with a Music Therapy group in Texas, USA.

Limelight confirmed that MacDonald’s “ research and ideas on improvisation have changed the way in which we deliver our activities by giving the work an explicit focus upon interpersonal and group communication” [5.2]. They emphasised that “improvisation by definition opens up musical involvement and interaction that allows for an inclusive, all-embracing and supportive approach,” and that “ there is no other musical activity which gives as much scope for involvement.” [5.2] They identified adults with autism, children and adults who feel marginalised and have low self-esteem, and disabled adults who have difficulty communicating, as groups that Limelight is now better able to work with to deliver innovative programmes with social benefits [5.2]. Through its collaboration with MacDonald, Limelight states that the company was able to work with an additional 80 adults from the disabled community in music training; 300 adults in music workshop settings; and 850 children in Nursery and Primary School settings [5.1]

MacDonald has a long working relationship with the Center for Music Therapy in Austin, Texas, and has collaborated with them on activities which use musical improvisation to improve health outcomes. He was instrumental in introducing musical improvisation therapies to the Center – training and literature in this area was ‘extremely limited’ in the USA prior to his involvement [5.3]. In May 2017 Macdonald contributed to the Movement Tracks project, which used improvisatory musical composition as a therapy for those living with the effects of stroke, Parkinson’s disease, cerebral palsy, and head injuries. The Center stated that “ The specific beneficiaries of Raymond’s work were myself, my staff (more than 225 therapists and interns), and our clients (more than 130,000 people). His books are still among the most consistently requested books at the Center.”

[5.3].

Beyond its application for improvement in psychological health and wellbeing, MacDonald’s work with the Center for Music Therapy led to the creation of the first musical recordings as a targeted physical therapeutic tool [5.3]. Through collaborative free improvisation, sonic experiences were developed to activate the parts of the brain that facilitate gait and improve balance for people who, owing to neurological or other health problems or injuries, walk extremely slowly at 4-39 steps per minute/beats per minute (spm/bpm) [5.4]. The Center explained that “the significance of creating auditory outputs at 4-39bpm is historic and profound” and that prior to these recordings it had been believed that music recordings of this speed were too slow to activate the brain's motor coupling benefits from musical improvisation. This research proved that this was not the case [5.5].

They also confirmed that electronic medical records and data from biomedical devices support “ faster, higher outcomes in gait when patients use this new music ‘Smarter Steps Volume 1’ incorporated in their PT [physical therapy] training” [5.3]. Beyond specific projects such as Movement Tracks, the Center estimated that from 2014, musical improvisation techniques have served as a key component of the therapeutic programmes of 25% of its clients – around 1,500 patients annually [5.3] – meaning these therapies reached approximately 1,800 people through the Center up to October 2019 (4.75 years).

As a result of the Movement Tracks project, the Center for Music Therapy produced a commercial recording of sub-40spm/bpm music. In 2017, this recording, Smarter Steps Volume 1 was licensed to the medical company Biodex for integration with its Gait Trainer 3 treadmill system, which is used in hospitals and rehabilitation centres worldwide. They stated that “ Since 2017 it is estimated over 500,000 patients have successfully used Smarter Steps Vol. 1 stems in their gait rehabilitation” [5.5] and that “ 100 facilities per year in Europe, the US and China now have Smarter Steps Volume 1 music to facilitate their movement that can match their heel strike from 5bpm/spm to 39spm/bpm and beyond.” [5.3]. Each facility purchasing the recordings has trained its full physical therapy team in its use [5.5]. The Centre for Music Therapy estimated that each facility would treat around 375 patients per month on average, with some – including three Italian hospitals which use a daily 15-20min treadmill session with Smarter Steps as a standard treatment protocol – treating much higher numbers of patients [5.3].

The opportunities for commercial development from the Movement Tracks project were such that the team went on to develop a new audio product – BioMedical Music™ – using the biofeedback from gait training, which improved patients’ walking speed and balance. In 2018, the company Biomedical Music Solutions was founded, which researches and develops ways in which artificial intelligence, gait analysis and BioMedical Music can be used together in a system called SoundSteps™ which stimulates the regions of the brain which improve gait and balance and helps prevent falls. The system is currently in use in the US, Italy, France, Germany, Switzerland and the UK, treating around 500,000 patients each year, and 100% of independently published research studies document faster improvements in walking and balance than in other systems [5.5].

The research has underpinned the creation of exhibitions and performances featuring entirely new forms of digital sound, thus extending the work of musicians, sound artists and curators. It has also enabled building engineers and reduced the cost of implementing architectural acoustic designs.

Creative practice

The NESS system has extended the potential for creative practice itself, through the introduction of entirely new virtual instruments, and enlarging widely the range of possibilities for digital sound.

The Hong Kong-based composer Samson Young used the NESS system to create an installation entitled Possible Music #1, exhibited at the Solomon R Guggenheim Museum in New York in the major exhibition One Hand Clapping (May to October 2018). In an interview for the Guggenheim blog, Young stated that using NESS “changed my idea” of how to create Possible Music #1 and praised the way NESS allows for a “ more ‘real’ form of sound synthesis than has existed before” [5.1]. The Guggenheim’s Associate Curator confirmed that the exhibition “ enabled us to explore new aspects of sound art and led to a better understanding of this unique art form” [5.2].

Trevor Wishart, a leading international figure in electroacoustic music, during an Edinburgh residency in 2014, wrote an eight-channel piece entitled Dithyramb: Kepler 63e, which forms a section of his three-part major work The Secret Resonance of Things. Wishart used NESS to synthesise an experimental virtual brass instrument, which he then learned to play. He has explained how NESS enhanced his creative process: “ The process of search and discovery I usually use – experimenting with sound transformation of existing (recorded) sounds in order to discover new sounds that are both plausible and musically effective – carried over naturally, here, into the domain of pure synthesis” [5.3].

Milan-based musician and producer Gadi Sassoon has made seven visits to Edinburgh since 2016, creating six pieces of multichannel music. Sassoon has worked extensively with both the offline NESS synthesis system and newer real-time products from Physical Audio. He wrote: “ Building music around the NESS sounds has led to the development of a new musical vocabulary, in terms of phrasing, harmony, arrangement and thematic development. In the realm of production of sound design, the introduction of these complex physical models into my workflow has pushed the envelope of how I approach dynamic processing, transient management and harmonic excitation: the richness of the sources [takes] texture and sonic sculpting to a new level” [5.4].

Audio technology and software development

A further influence on creative practice relates to new possibilities for immersive sound. All music created on the NESS system is multichannel in nature; sounds from a single instrument can be performed using as many loudspeakers as desired. Though most works were created for 8 loudspeakers, Gordon Delap’s Black Dog was created in 32 channels as a work specially designed for the Immersion-Experience exhibition at the Société des Arts Technologiques in Montréal, Canada in 2016 and he continues to create work that is influenced by the project [5.5]. Sassoon’s album Multiverse, created using the NESS system and released in 2020, was remixed in VR/AR format and the album is now being used as a demonstration showcasing immersive audio Atmos technology by Dolby Laboratories [5.6]. Multiverse charted at #1 on three charts – Ambient, Leftfield and Experimental Electronic – on Juno, the largest vinyl distributer in the world, in the week of its release [5.6].

Public performances and releases

The new technology has reached the public through more than 60 performances in 19 countries between 2014 and 2020.

Wishart’s The Secret Resonance of Things has been performed 22 times internationally and featured in a series of sound installations at the Centro de Cultura Digital, Mexico City, which received 9,000 visitors from June to July 2015 [5.7]. The Secret Resonance of Things was released on CD by SoundOhm in 2017. Young’s Possible Music #1 at the Guggenheim was part of the One Hand Clapping exhibition which occupied two of the seven floors at the museum, which typically receives over 1m visitors annually [5.2]. A follow-up project, Real Music, was featured at the Talbot Rice Gallery at the University of Edinburgh (July to October 2019) as part of the Edinburgh Art Festival, with 11,978 attendees, the highest for any exhibition that year. The Gallery’s Director noted that Young’s work “ demonstrates how a highly specialised branch of physics can have a role in contemporary art […] with both parties helping to push each other's boundaries” [5.8]. Delap’s 16-channel installation Ashes to Ashes was exhibited at the Dublin Science Gallery in 2017 [5.5].

Architectural acoustics

The virtual and architectural acoustics system based on NESS has informed building designs in Oman. The system was used in the acoustic fitting of the British School Muscat (Oman) by Atlal Al Qurum acoustic consulting. The more accurate modelling of the building’s acoustics enabled Atlal Al Qurum to address problems in the sound design prior to the construction stage; an acoustician confirmed that “ If we hadn't noticed the flutter echoes at the construction stage itself, fixing it would have a considerably higher overall cost implication for the client” [5.9].

The making of Seven Songs provided palliative relief to the project’s participants. The film itself has raised public awareness and changed perceptions of palliative care, and informed the work of hospices, charities, and healthcare education and practice. This was achieved through cinema screenings locally and nationally as well as a post-screening workshop which encouraged discussion of end-of-life among patients, their families and the general public. As a senior staff member at the University of Edinburgh Medical School puts it: “ this film is something different. It helps talk about uncertainty which actually most doctors and nurses are much less trained for.” [5.1]

Palliative relief for patients

Statements from Strathcarron Hospice patients and staff testify that Hardie’s approach to filming led to palliative relief. Participants praised the project as “absolutely amazing”, “very relaxing”, “something to look forward to”, “good fun” and a “marvellous, marvellous comforter” for relatives. Patients also noted the sense of acceptance that came from seeing themselves on film:

“I didn’t really see myself like that until I saw it on the film… And I think in a way I thought it was quite good because I thought, well, it’s like an acceptance.” [5.2]

The project created a collaborative legacy for families, capturing elements of everyday life as well as special moments the families chose to record:

“My family… they really liked it. I think secretly they know that they can still have Mum on it when I’m not here, so it’ll be good.” [5.2]

The Palliative Care Research Network newsletter (February 2016) reported that Strathcarron patients valued the opportunity “ to tell their personal story, to be seen as strong individuals … and not just weak and vulnerable patients.” [5.3]

Raising public awareness and changing perceptions of palliative care

Seven Songs was screened to audiences in over 250 cinemas in 15 countries, and at 160 community-organised screenings in the UK. It has been invited to over 40 international film festivals and conferences and was nominated for five awards in 2016, including Best Single Documentary at the Scottish BAFTAs [5.4]. It had a higher than average (9%) audience share for its UK transmission on BBC Two Scotland, with a terrestrial audience of 101,000 in Scotland [5.5] and screened on the national US public television network PBS 1,401 times up to November 2017 [5.6], accompanied by a dedicated website which included downloadable educational resources. In May 2016, the film was screened at 14 events with accompanying workshops around the UK as part of Dying Matters Awareness Week [5.6].

There was extensive coverage of the film in the press in the UK and overseas – including four-star reviews in The Guardian newspaper and Total Film magazine, and a recommendation as one of the best films of the year in Vulturehound magazine [5.7] – demonstrating the positive reception the film received. A dedicated campaign on social media [5.5] for the film’s premiere in September-October 2015 generated 6,249 views of the film’s trailer and accompanying videos on YouTube; 144,700 impressions on Twitter; and Facebook posts which regularly reached over 4,000 people. Seven Songs was included in highlight features for the SXSW 2016 line-up in press including IndieWire and Variety magazine, and REM posted about the film’s PBS transmission on their Facebook page, which has around 4.4 million likes: “ an awesome documentary… A special shout out goes to Mandy, the nurse who sang the duet of ‘Everybody Hurts’” [5.7].

Post-screening evaluations undertaken by Hardie in conjunction with UoE’s Scottish Collaboration for Public Health Research and Policy (SCPHRP) showed how the film changed public perceptions about planning for end-of-life and palliative care: 86% of those surveyed at screenings of the film came to the realisation that hospice care can be part of life, and 96% stated that they would recommend Seven Songs as a resource for helping others approach a terminal diagnosis [5.8].

Enhancing the profile of the work of hospices and palliative care charities

44 screenings in hospices around the UK (including in partnership with Hospice UK for Hospice Care Week 2015) were each accompanied by workshops exploring ideas around end-of-life and training resources [5.6]. Some of the Strathcarron patients who feature in Seven Songs took part in a roadshow of Q&A sessions alongside these screenings, reflecting on the experience of filming, the idea of leaving a legacy and of accepting change.

Partnerships were formed with 11 UK and 13 international palliative care charities, through which the film was offered as a tool to facilitate dialogue around end-of-life within their networks and with the wider public through screenings and events. These engagement opportunities contributed to raising the profile of these charities and the services they provide. Hospice UK confirmed that:

“This film tells the story of joy and honesty even in the face of serious illness and impending death. It shows the power of attentive and flexible hospice care to help people reconnect to what matters in their life – whether it is music, memories, families or simple everyday things. The power of patients bursting into their favourite song is startling and the film captures these poignant moments unselfconsciously and tenderly” [5.9].

Informing healthcare education and practice

In line with the Scottish Government’s Strategic Framework for Action on Palliative and End of Life Care, medical professionals and educators have used the film to encourage discussions around end of life. Healthcare Improvement Scotland notes that:

“Giving health and care professionals and members of the public access to the stories of real people as portrayed powerfully in ‘Seven Songs for a Long Life’ enables people to have greater understanding about the benefits of Anticipatory Care Planning which is essentially about individuals and those who are supporting them thinking ahead.” [5.10]

The film can be used within the NHS as part of nursing continuing professional development (CPD) and revalidation [5.11]. The Queen’s Nursing Institute Scotland identified the importance of Seven Songs in the relationship that nursing staff build with patients:

“For me as a nurse, this is a really powerful film. Being alongside people and their families at the end of their lives and sharing that journey is the most incredible privilege… Being present as a fellow human being, as a companion, sharing the moments of joy and the pain. That is the essence of nursing and ‘Seven Songs for a Long Life’ portrays this with tenderness and sensitivity.” [5.11]