The Leap Motion Controller in Clinical Music Therapy

A Computer-based Approach to Intellectual and Motor Disabilities

Adriano Barat

, Antonio Elia

, Luca A. Ludovico

and Eleonora Oriolo

Laboratorio di Informatica Musicale (LIM), Dipartimento di Informatica, Universit

a degli Studi di Milano, Milan, Italy

Helvetic Music Institute, Bellinzona, Switzerland

Keywords:

Music Therapy, Computer-Supported Education, Leap Motion.

Abstract:

This paper describes a technological approach to overcome motor and intellectual disabilities through musical

expression. In the context of clinical music-therapy sessions, we propose the introduction of ad-hoc hardware

sensor devices to improve free-hand interaction and to foster the development of communication and motor

skills. Multiple educational aspects are involved, ranging from the ability for the disabled to play together

in a non-competitive environment to the achievement of tangible rehabilitation results. The proposed system

captures user’s gesture through a Leap Motion controller, and the signals thus generated are sent to a software

tool that converts movements into music notes. These activities have been integrated into music-therapy

sessions held at a renowned rehabilitation center and successfully experimented on a control group.

1 INTRODUCTION

The development of suitable computer-based tech-

nologies may help people with serious disabilities

communicate and control the surrounding environ-

ment by using alternative interfaces. Technological

advances can greatly improve the quality of life by

providing access to work and entertainment activities.

Scientiﬁc research has clearly identiﬁed the im-

portance of music in the physical and intellectual re-

habilitation of disabled people. In this sense, it is

worth mentioning some works that investigate the re-

lationship between music and disability in history, so-

ciety, and culture, such as (Lerner and Straus, 2006),

(Lubet, 2011), and (Straus, 2011).

From an educational point of view, practicing a

musical instrument presents many challenges: it re-

quires manual and listening skills, as well as the abil-

ity to face the threats typical of a learning environ-

ment, such as focusing on a performance goal, gath-

ering feedbacks to improve performance, reinforc-

ing self-conﬁdence, and developing a psychological

and behavioral toolkit against pressure and problems

(Martin, 2008). This is particularly true when work-

ing with people with disabilities, due to their physi-

cal and intellectual impairment. As clearly stated in

(Ludovico and Mangione, 2014), ad hoc music learn-

ing environments can foster self-regulation abilities in

students, by covering a 3-phase cyclical process: fore-

thought, performance or volitional control, and self-

reﬂection (McPherson and Renwick, 2001).

The mentioned aspects, which involve self-

awareness and encourage self-improvement, are cru-

cial factors in the design and implementation of in-

terfaces to let people actively join music experiences;

but, despite the increasing number of enabling tech-

nologies and support tools, the access to music per-

formance and creation still presents many obstacles

for people with physical and intellectual disabilities.

In literature, the term enabling technology desig-

nates a technology that alleviates the impact of dis-

ease or disability. According to (Hansson, 2007),

4 categories can be recognized, according to how

their impact is distributed between the individual and

the surrounding society: 1. therapeutic (restoring the

original biological function that has been lost or pre-

venting further losses), 2. compensatory (replacing,

fully or partially, a lost biological function by a new

function of a general nature), 3. assistive (allowing to

perform a task or activity despite an uncompensated

disability or lack of function), and 4. universal (i.e.,

intended for general use) technology.

A recent device able to cover multiple categories

of enabling technology is the Leap Motion controller.

First released in 2012, it is a computer hardware sen-

sor device able to track hand and ﬁnger motions as

input, requiring no hand contact or touching. This

USB peripheral device was originally designed to be

Baratè, A., Elia, A., Ludovico, L. and Oriolo, E.

The Leap Motion Controller in Clinical Music Therapy.

DOI: 10.5220/0006771204610469

In Proceedings of the 10th International Conference on Computer Supported Education (CSEDU 2018), pages 461-469

ISBN: 978-989-758-291-2

461

Figure 1: The Leap Motion controller.

Figure 2: A software application that shows hand and ﬁnger

tracking by the Leap Motion.

placed on a physical desktop, facing upward (see Fig-

ure 1). Using two monochromatic IR cameras and

three infrared LEDs, the device observes a roughly

hemispherical area to a distance of about 1 meter,

catching about 200 frames per second. Data are sent

to the host computer, where 3D position of hands and

ﬁngers are synthesized by comparing the 2D frames

generated by the cameras (see Figure 2). As demon-

strated by independent tests, the overall average ac-

curacy of the controller is about 0.7 millimeters (We-

ichert et al., 2013).

Thanks to its intrinsic characteristics, the Leap

Motion controller has been already adopted in a num-

ber of medical and therapeutic applications. Of-

ten, this tool is used to allow free-hand interaction

in the treatment of physical injuries, including ap-

plications for hand rehabilitation (Liu et al., 2015;

Taylor and Curran, 2015), gesture recognition to re-

cover the functionalities of upper extremity (Gieser

et al., 2015), and stroke rehabilitation (Khademi et al.,

2014). Other works – e.g., (Iosa et al., 2015) and (Zhu

et al., 2015) – explicitly address the possibility to treat

cognitive and intellectual disabilities.

In music research the potential of the Leap Motion

to intuitively generate and/or control a performance

is currently under investigation. This technology is

seen as a new interface for music expression, as stated

in (Ritter and Aska, 2014), and implementations em-

brace ﬁelds such as sound synthesis and interactive

live performance (Hantrakul and Kaczmarek, 2014).

Much has been written about the sociocultural di-

mensions of the interface between the human body

and technologies. It is worth citing (Haraway, 1991),

(Penley and Ross, 1991), (Gray et al., 1995), and

(Halberstam and Livingston, 1995), to name but a

few. The introduction of new computer technologies

such as augmented and virtual reality has risen in-

terest in how the ontology of bodily experience and

selfhood are altered via the human/machine interface

(Riva et al., 2016). Conversely, the ways in which

technologies can contribute to the meanings and ex-

periences of the lived body/self with disabilities has

been explored to a lesser extent (Lupton and Seymour,

2000).

The approach described below tries to draw full

beneﬁt from the features of the Leap Motion, com-

bining its potential in the therapeutic and rehabilita-

tive ﬁelds with the possibility for (disabled) users to

intuitively control the parameters of musical expres-

sion.

In this context, the deﬁnition “computer-based

education” assumes multiple meanings: on the one

hand, it means employing enabling technologies to

learn the use of a virtual musical instrument, on the

other it involves re-education in the development or

recovery of physical and intellectual abilities.

The paper is structured as follows: Section 2 will

describe the clinical framework of the initiative, Sec-

tion 3 will provide technical details, Section 4 will

show the point of view of the music therapist, ﬁnally

Section 5 will assess the experience presenting some

measurable results.

2 BACKGROUND

The computer-aided therapeutic activities described

in the present work were experimented – and are still

ongoing – at an Italian rehabilitation center called

Sim-patia.

The mission of this social cooperative is to give

disabled persons a future perspective by minimizing

the effects of their handicap and promoting their au-

tonomy. In this context, guests are invited to consider

their life condition not as a situation that prejudge the

Cooperativa Sociale Sim-patia, Via G. Parini 180,

22070 Valmorea (CO), Italy, http://www.sim-patia.it/

CSEDU 2018 - 10th International Conference on Computer Supported Education

462

Figure 3: Music therapy at Sim-patia in a “traditional” set-

ting.

possibility of fully expressing themselves, rather as an

invitation to acquire new abilities in order to achieve

such a result. Sim-patia’s motto is: “With the disabil-

ity, life just changes but it does not ﬁnish”.

Guests are stimulated to exploit their potential and

skills, even in highly compromised situations, in or-

der to develop communication and motor autonomy

to be spent in everyday life. This goal is achieved

by advanced technological solutions, speciﬁc equip-

ment to meet individual needs (e.g., special key-

boards, bone-conduction headphones, eye-gaze con-

trollers, etc.), and scientiﬁc collaborations involving

specialists, academia, and research centers.

In particular, the technology center at Sim-patia is

the area devoted to the study and realization of hi-tech

solutions. Starting from the analysis of the individual

needs of the disabled, a team composed by therapists,

engineers and computer experts designs and develops,

or adapts, devices useful for everyday house manage-

ment, work, communication, and leisure time.

Sim-patia offers cognitive and logopedic thera-

pies, manual and creative activities, virtual travels,

cinema clubs, and workshops on gardening, theater,

and music. As it regards the latter aspect, sound and

music education plays a key role in rehabilitation.

The disabled is invited to develop music-based com-

munication skills through the interaction with the en-

vironment and non-competitive peer cooperation, in

the context of group activities guided by a music ther-

apist. Research work – such as (Karageorghis and

Terry, 1997), (Scheufele, 2000), and (Schlaug et al.,

2005) – studied the effects of music on the develop-

ment of memory, language, rhythm, attention, sense-

perceptual skills, communication, and relaxation.

A music therapy session at Sim-patia, like the one

shown in Figure 3, is organized as follows:

• introduction to a given author or music genre pre-

viously selected by the group;

• listening activities aiming to catch the attention of

the patient and create a pleasant climax;

• sound-based games;

• motor games based on sound/gesture association

and expressive motion;

• rhymes, and vocal, sung, and mimed songs;

• guided relaxation.

In this framework, a scientiﬁc cooperation be-

tween Sim-patia and the Laboratory of Music In-

formatics

of the University of Milan originated a

computer-based solution that provides or extends the

interaction of disabled people with music during ther-

apeutic sessions.

This kind of music-based rehabilitation addresses

3 groups of patients, with 8 to 10 participants per

group and homogeneous for pathologies: the ﬁrst

group includes users with cognitive disabilities and

some cases of moderate motor disability, the second

group is formed by boys up to 25 years old with mo-

tor and cognitive disabilities and autism, and the third

group are users in a wheelchair due to trafﬁc acci-

dents. The time schedule is approximatively one hour

per group, repeated once a week, organized as fol-

lows: 45 minutes of practical activities plus 15 min-

utes of ﬁnal discussion, open to educators’ and pa-

tients’ comments.

No patient is excluded a priori, but some patholo-

gies require particular sensitivity and patience. For

example, this is the case of autistic children, who need

more time than others to get in touch with the setting.

3 THE PROPOSED SOLUTION

The goal of the computer-based application is to let

patients generate music (in terms of pitch and rhythm)

by playing a virtual instrument in a free-hand and no-

contact context. The sequence of notes provides a sort

of leading voice that the music therapist accompanies

with the guitar.

The overall system is composed by hardware (a

computer with a Leap Motion attached) and software

components (a specially designed browser application

that integrates the LeapJS framework in order to com-

municate with the hardware device). One of the goals

of the proposal was to keep both computer require-

ments and expenses to a minimum, so as to make the

implementation simple, cost-effective, and easily re-

producible in other contexts. Aside from the purchase

Laboratorio di Informatica Musicale (LIM),

http://www.lim.di.unimi.it/

The Leap Motion Controller in Clinical Music Therapy

463

Figure 4: The main window of the browser interface. Horizontal sections can be customized in color, number and pitch

association during the set-up phase. The cursor provides a feedback on the current hand position.

of the controller, which is anyway a low-cost device,

the other requirements can be easily fulﬁlled.

The browser application allows users to play a vir-

tual musical instrument with a hand movement from

the bottom up and vice versa, providing a graphical

feedback of the relative position of the hand. The

space above the controller is vertically segmented into

a number of rectangular areas, each one referring to a

different note pitch and represented on screen through

a colored section (see Figure 4). When the dis-

tance between hand and controller exceeds a thresh-

old value, this gesture triggers the production of a new

sound. If the hand remains in a given area for a prede-

ﬁned amount of time, a new note with the same pitch

is performed.

User interaction is deliberately simple, so as to re-

spond to the constraints posed by the clinical situa-

tion of seriously disabled people. For example, the

horizontal position of the hand could ba tracked as

well, but we decided to ignore data on this axis. If

the therapist should decide to detect horizontal move-

ments instead of vertical ones, the Leap Motion could

be easily rotated, and also the interface accordingly.

Some parameters can be customized during the

set-up phase, in order to better meet speciﬁc needs.

First, the capture range can be ﬁne-tuned by determin-

ing the minimum and maximum distance from sen-

At the moment of writing, the Leap Motion controller

is sold for less than $80.

sors that each user can cover with his/her gestures.

The declared range of the device is 25 to 600 mm, but

often the movements of patients are far more limited.

Moreover, conﬁguring the actual capture area allows

to place the device in non-standard position and ori-

entation.

Another parameter that can be ﬁxed is the number

of horizontal sections the total area is divided into, or

alternatively their height. This value sets the number

of different pitches supported by the interface. For ex-

ample, paraplegic patients as well as seriously injured

people may experience great difﬁculty in moving the

limbs and pointing precisely: in this case, it is possi-

ble to adopt a setting with few but well-deﬁned areas.

For different reasons, giving the option to perform

only a limited number of notes can encourage users

with intellectual disabilities, without causing them a

sense of frustration.

Please note that the mentioned parametrization,

basically intended to provide the user with a comfort-

able interface, can be also turned into an instrument of

motivation and engagement. For instance, the experi-

ence described in Section 5 showed that, after an ini-

tial learning and adaptation phase, some patients were

eager to play with richer and more complex conﬁgu-

rations, implying a higher number of notes.

Other parameters customizable through the inter-

face are less functional to rehabilitation, but they

make music experience more engaging. For exam-

ple, speciﬁc pitches can be associated to the horizon-

CSEDU 2018 - 10th International Conference on Computer Supported Education

464

tal sections, thus supporting typical progressions and

cadences (e.g., the I-V or I-IV-V progression), scale

models (e.g., the pentatonic or the whole tone scale),

and altered notes to play in speciﬁc keys. Another op-

tion concerns the timbre of the virtual instrument in

use.

The graphical interface was designed keeping

simplicity in mind. Implemented as a browser ap-

plication in HTML5 and JavaScript, the main page

presents a number of colored horizontal sections cor-

responding to pitches and a hand-shaped cursor that

provides visual feedback on the rough position of the

hand. It would be easy to track and graphically rep-

resent further or more precise information. For in-

stance, the Leap Motion technology can track both

hands and even single ﬁnger bones, and, concern-

ing the interface, a hand and ﬁnger 3D visualizer is

already available in the extension framework called

LeapJS. Nevertheless, the music therapist discour-

aged a ﬁner level of granularity, considering it mis-

leading for patients affected by intellectual disability

and frustrating for those presenting physical impair-

ment.

4 THE MUSIC THERAPIST’S

POINT OF VIEW

A subjective way to evaluate the initiative was an in-

terview with the music therapist working at Sim-patia,

who played a key role both in the design and in the

test phase of the computer-based solution (see Figure

5). Being an expert domain, his remarks will be help-

ful to assess the educational valence in the context of

physical and intellectual stimulation of people with

disabilities. A more objective way to assess the expe-

rience, based on measurable results, will be provided

in Section 5.

First, the therapist motivated the design choice to

map pitches onto the vertical dimension. In West-

ern tradition, there is the cultural assumption that

acute pitches “go upwards” as they are compared to

light and purity, whereas low pitches are associated

to darkness and gravity. Consequently, it is more in-

tuitive for anyone – especially for a child or a person

with intellectual disability – to link high and low notes

to the upper and lower part of the body respectively.

Another important point to clarify is the possibil-

ity to customize the pitches that users can play. Since

the interface addresses – in general – persons with

no previous music training, and presenting different

levels of disability, either motor/physical or cogni-

tive/intellectual, the goal of creating melodic aware-

ness for them is not trivial. Rather than providing

Figure 5: A disabled person interacting with the system.

users with a traditional diatonic scale (e.g., the eight-

grade C major scale), the proposed virtual instrument

supports (potentially) smaller sets of pitches. Even a

minimal subset of natural notes – formed, e.g., by C

and D – showed to be effective in producing articu-

lated melodic events. In fact, these two pitches can be

intuitively associated to the ideas of rest/conclusion

and tension/suspension, also supported by the adap-

tive guitar accompaniment of the music therapist. Af-

ter a short time, users realize that their gestures are

producing something similar to a dialog.

Complexity – that implies a higher level of difﬁ-

culty, but also greater expressive potential – can be

raised by adding notes. As a result, patients are mo-

tivated to interact with the musical accompaniment,

being rewarded by the achievement of richer melodic

tunes. Interaction with external musical stimuli can

be fostered also through a suitable choice of the pitch

set. For instance, the pentatonic scale, presenting no

halftone interval, is easily adaptable to any accom-

paniment, consequently it has been extensively used

during music-therapy sessions.

In conclusion, during the interview the music ther-

apist showed a high degree of appreciation towards

the interface, described as an enabling device that en-

hances the traditional therapy sessions by encourag-

ing the patients’ interaction with music.

5 ASSESSMENT

After verifying the effectiveness of the computer-

based framework from the therapist’s point of view,

the research questions to be answered are if and

to what extent its adoption has allowed patients to

progress on their rehabilitation.

The approach adopted at Sim-patia is based on the

Phenomenological-relational Methodology by Paolo

The Leap Motion Controller in Clinical Music Therapy

465

Figure 6: Observation form in use at the Helvetic Music

Institute, originally prepared by P. Cattaneo and A. Elia for

experimental music therapy projects at the Case per Anziani

del Canton Ticino.

Cattaneo (Cattaneo, 2009; Elia, 2017) and focuses on

the centrality of musical language, that aims at the

construction of the therapeutic relationship and is in-

tended as an “active principle” linked to the cultural

dimension and neurobiochemical responses.

The music therapist used an observation form (see

Figure 6) to track improvements during the period

of therapy. This document, compiled at the begin-

ning and at the end of the rehabilitation path, al-

lows to objectively evaluate the evolution occurred in

the psycho-physical, affective-emotional and cogni-

tive ﬁeld, thus showing the results achieved for each

participant through therapeutic intervention. The mu-

sic therapist is asked to express his opinions through

a 4-point Likert scale.

The principle on which the evaluation form is

based takes into consideration the three main ele-

ments of musical language, i.e. rhythm, melody and

harmony, and combines them with the three main di-

mensions of the human system, namely movement,

emotion and thought. The three main areas are de-

tailed in sub-areas that speciﬁcally describe the par-

ticipant’s responses to the music-therapy setting. In

this experimentation, only the signiﬁcant part of the

form was used.

Due to the peculiar characteristics of this experi-

ment, the therapist recorded additional data concern-

ing the capabilities achieved across multiple sessions,

i.e. the range of distances from the Leap Motion that

the user was able to reach (wider ranges correspond to

better motor skills) and the number of notes proposed

to the patient (higher values imply a better ability to

control gesture).

Concerning the range, it is worth underlining that

some patients were able to cover the full interval,

spanning from 25-50 to 600 millimeters. In this sense,

patients with autism were particularly skilled, but –

more surprisingly – also some users with motor dis-

ability were able to achieve this remarkable result.

The average number of notes proposed to users

was 5, considerably above the minimum subset of 2

notes mentioned in the Section 4. This value is rel-

evant both for people with motor disabilities, who

could experience difﬁculties in precisely pointing an

area, and for people with intellectual disabilities, less

prone to interact with music.

Table 1 summarizes the results of the experimen-

tation conducted on a group of 9 patients at Sim-

patia. The test set is heterogeneous as it regards age,

genre, and pathology. The latter aspect required to

customize the parameters of the interface, and specif-

ically to calibrate gesture captures and to ﬁx the num-

ber of playable notes. For the sake of brevity, the

last column provides an average value of the multi-

dimensional data from the observation form. Even

if starting from different levels, the therapist regis-

tered improvements in all his patients in a very limited

number of sessions. It is worth noting that: User 3,

despite his motor disability, was able to cover the full

range of distances and to play a whole 8-grade scale;

User 5, affected by quadriplegia, obtained very en-

couraging results in terms of motion ability; and User

7, presenting autism spectrum disorder, was success-

fully administered a non-trivial 5-grade scale.

In general terms, making autistic patients interact

with the interface and produce music together with the

therapist was a remarkable success. Anyway, this cat-

egory of users showed innate musical abilities, being

able to easily memorize tunes and reproduce them.

6 CONCLUSIONS

In this work, we have described a computer-based ap-

proach to encourage the interaction of disabled peo-

ple with music content during music-therapy sessions.

Starting from educational roots and clinical require-

ments, with the help of experts from different do-

mains (behavioral and rehabilitative medicine, music

CSEDU 2018 - 10th International Conference on Computer Supported Education

466

Table 1: Evaluation of the results achieved through music-therapy sessions. Values in the last column are expressed – session

by session – in a 4-point Likert scale.

User Genre Pathology Parameters Session Results

1 M

Mean mental retardation, spastic hemiplegia

and hemiparias at unspeciﬁed hemispherical site,

predominant emotionality disorders

start = 50 mm

end = 600 mm

notes = 6

2 F

Intellectual disability with infant cerebral palsy

and bilateral spastic tetrapareris

start = 25 mm

end = 300 mm

notes = 3

3 M

Spastic quadriplegia, severe mental retardation,

dysphasia

start = 25 mm

end = 600 mm

notes = 8

4 M

Childhood autism with pervasive developmental

disorder, moderate cognitive delay and echolalia

start = 25 mm

end = 500 mm

notes = 6

5 M Quadriplegia caused by street trauma

start = 50 mm

end = 400 mm

notes = 4

6 F Motor disability

start = 100 mm

end = 300 mm

notes = 3

S1 2

7 M Autism spectrum disorder

start = 25 mm

end = 600 mm

notes = 5

8 M Brain cerebral hemorrhage with femoral fracture

start = 50 mm

end = 600 mm

notes = 6

9 M Autism spectrum disorder

start = 50 mm

end = 600 mm

notes = 4

and musicology, computer science) we have designed

and released a framework that was tested in a clinical

context, showing encouraging results.

Based on the Leap Motion, the application imple-

ments a simpliﬁed and intuitive virtual instrument that

gives musically-untrained disabled people the chance

to create a music tune, picking available pitches from

a user-tailored set. The musical experience is highly

customizable, depending not only on the type and

level of disability to treat, but also on the skills and

motivation developed by users during their rehabilita-

tion path.

As a relevant result, the creation of recurrent musi-

cal patterns becomes a recognizable element that trig-

gers formal processes. Thanks to sound, the whole

psychomotor sphere is stimulated: through live in-

teraction, a gesture produces a clearly recognizable

sound feedback, and the effect is the feeling to play

and achieve the desired musical result, even in ab-

sence of a physical contact.

This computer-based project presented multiple

educational meanings. First, thanks to the Leap Mo-

tion, disabled people were encouraged to play to-

gether in a non-competitive environment, learning

music concepts intuitively (e.g., melody, rhythm, har-

mony, synchronization, etc.). Another form of edu-

The Leap Motion Controller in Clinical Music Therapy

467

cational achievement can be seen in the rehabilita-

tion results fostered by this approach, which moti-

vated users and pushed them to overcome their lim-

its in order to reach new goals (e.g., a more pre-

cise pointing or a higher number of available notes).

But another educational valence of the proposed ap-

proach emerges in a ﬂipped context, since the thera-

pist himself learned something about his patients from

the musical interaction they were able to produce to-

gether.

Concerning future work, we plan to track patients’

improvements over a longer period, extend this early

experimentation to a wider test group, and propose

such a computer-based solution to other therapists and

rehabilitation centers.

ACKNOWLEDGMENTS

The authors gratefully acknowledge the staff of Sim-

patia, and in particular the IT responsible Nicola Li-

boni, for their help and support.

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