1. Squeak is not the only Smalltalk that should be considered for real-time multimedia applications. My "Siren" package for sound/music was originally developed in Xerox PARC Smalltalk (in 1984), then evolved along with the commercial VisualWorks family. For a few years (1997-2001), its main platform was Squeak, but we moved it back to Cincom's VisualWorks non-commercial (VWNC) about 2 years ago. VWNC is free for non-commercial applications; it is the full Xerox/ParcPlace lineage Smalltalk system.
We gave up on Squeak because of issues with its performance, stability, poor development tools, non-support for team programming, non-support for object databases and CORBA ORBs, and the confusion about its multimedia I/O facilities.
In VisualWorks, Siren uses the "DLCCC" API (like native methods in Java) to access streaming sound and MIDI I/O. The GUI builder is excellent, the VM performance is awesome, and it's been stable for a decade or so. We're planning a new release of the VWNC-based Siren for later this month.
2. An open VM is not as important as a VM that can be easily extended with interfaces to low-level facilities. If I can write reliable real-time programs, and access external facilities easily, I'd actually rather *not* have to muck around in the VM.