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Healthy musicianship: prevention, cures and
challenges in musician‘s medicine
Eckart Altenmüller
Institute of Music Physiology and Musicians��Medicine (IMMM) Hannover University of Music, Drama and Media
[email protected] www.immm.hmtm-hannover.de
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1. The facts – student`s complaints
2. The means - institutions and programs 3. The contents - How to practice?
4. The consequences – Prevention of Dystonia
5. Summary and Outlook
Structure
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Prevention in Music Academies 25% of beginner students start their studies with pain deteriorating their performance 68-88% of music students have at least once during their studies medical problems caused by music making 45% of music students seek professional help because of these medical conditions From: Spahn C. et al. 2002, 2004, MPPA
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1. The facts – student`s complaints
2. The means - institutions and programs 3. The contents - How to practice?
4. The consequences - Avoidance of pain 5. Summary and Outlook
Structure
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The Institute of Music Physiology and Musician�s Medicine today www.immm.hmt-hannover.de
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Teaching activities
Outpatient Clinic
Research programs
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Lecture: Music Physiology
Feldenkrais
External Physiotherapy
Stage fright coaching
Outpatient clinic for music students
Mental Training
Breathing-/ Voice- Speech education
Counseling
Yoga body awareness
External: Sports/ Psychological Counseling
Health Program for Music Students
concept Winter-Term 2013/2014
Outpatient clinic for musicians� disorders: free of charge!!!
Auditions-Training
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Courses and Tutorium this semester: Lectures for students: Music Physiology (weekly)
→ obligatory for students in instrumental pedagogy (later teachers) → obligatory for all performing musicians → elective for BA / MA in Musicology and Music education
Tutorium for students: (2 hours weekly) → obligatory for students in instrumental pedagogy (later teachers) → obligatory for all performing musicians
Voluntary seminars on: Helps Brain Science Musicians? „Neurosciences of music“
IMMM
Music Physiology:
What is going on in the body in music making
what problems can you have
how can you avoid them
what are the most efficient practice strategies
why are they efficient
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1
DIE KÖRPERLICHEN UND GEISTIGEN GRUNDLAGEN DES MUSIZIERENS (Prof. Dr. med. Altenmüller, Dr. med. Andre Lee) 17. 10. Einführung in das Fachgebiet und körperliche Grundlagen des Musizierens 24. 10. Muskeln, Nerven, Sehnenscheidenprobleme 31. 10. Sensibilität und Körperwahrnehmung 7. 11. Muskelphysiologie und Trainingseffekte durch Übung 14. 11. Senso-Motorik bei Musikern 21. 11. Senso-Motorisches Lernen bei Musikern 28. 11. Mentales Üben 5. 12. Übetechniken 12. 12. Schmerzen beim Üben: Ursachen, Vorbeugung und Behandlung 29. 12. Physiologie des Gehörs 9. 1. Ursachen und Vorbeugung von Gehörschäden bei Musikern 16. 1. Psychologie für Musiker – Selbstvertrauen, Wettbewerb und Ängste 23. 1. Lampenfieber: Ursachen 30. 1. Lampenfieber: Vorbeugung und Behandlung 6. 2. Klausur (wird benotet und ist Grundlage der Abtestate) 13. 2. Schlußbesprechung: die 10 Weisheiten zum Semesterabschluß
Practice strategies
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Lecture "Music Physiology": Relevance of topics
0
2
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1: irrelevant 2 3 4 5 6: crucial
No.
of
answ
ers
Evaluation
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Lecture "Music Physiology": Applicability in everyday practicing
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1: noapplicability
2 3 4 5 6: highapplicability
No.
of a
nsw
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Evaluation
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1. The facts – student`s complaints
2. The means - institutions and programs 3. The contents - How to practice?
4. The consequences – Prevention of Dystonia
5. Summary and Outlook
Structure
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Relation between the amount of daily practice trials of skilled finger movements and improvement
(Hettinger et al. Geschicklichkeit und deren Übbarkeit. Z.Arbeitswiss.1975;29:223)
Zunahme der Fingergeschicklichkeit nach zweiwöchiger Übung in Abhängigkeit von der Zahl der Arbeitsbewegungen pro Übungseinheit.
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The Penelope-effect
(Hettinger et al. Geschicklichkeit und deren Übbarkeit. Z.Arbeitswiss.1975;29:223)
Zunahme der Fingergeschicklichkeit nach zweiwöchiger Übung in Abhängigkeit von der Zahl der Arbeitsbewegungen pro Übungseinheit.
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John Williams Waterhouse: Penelope and the suitors (1912)
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The Penelope-effect
(Hettinger et al. Geschicklichkeit und deren Übbarkeit. Z.Arbeitswiss.1975;29:223)
Zunahme der Fingergeschicklichkeit nach zweiwöchiger Übung in Abhängigkeit von der Zahl der Arbeitsbewegungen pro Übungseinheit.
Teach the art to stop practicing in the right moment
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Reasons for Deterioration 1.) Loss of motivation 2.) Loss of attention 3.) Fatigue of the muscles
Conclusion: Never practice un-attentively Never practice when fatigued Include pauses in your practice schedule Organize your practice schedule interestingly
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Leimer K, Gieseking W: The shortest way to pianistic perfection. 1932 Gieseking W, Leimer K: Piano Technique. Dover: 1972
G. was able to study new pieces by reading the music. Once he started to read a completely new piece on the railway-trip to the town where he was supposed to play the same night. There he played that piece - from memory. Today : Piano Technique. Including “The shortest way...” + “Rhythmics, Dynamics, Pedal and other problems of Piano Playing” by Leimer-Gieseking, originally publ. 1938
The Art of Mental Practice:
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Structural memory
Sensory memory
Motor memory
Inner hearing
Visual memory
The five pillars of mental training: Work conducted together with Nicolo Bernardi,
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„Mental Super-Experts�: 30 Minuten reading music of Scarlatti
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p <0.001
n.s. n.s.
mental physical mental + physical + physical physical
Mental practice is effektive!
From: Bernardi et al. Music Perception 2013
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1. The facts – student`s complaints
2. The means - institutions and programs 3. The contents - How to practice?
4. The consequences – Prevention of Dystonia
5. Summary and Outlook
Structure
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Definition Musicians‘ Dystonia is a loss of motor control of skilled movements necessary for instrumental playing. It occurs usually without pain.
Prevalence amongst musicians: 1-2 %
It is still an unresolved problem. It remains difficult to treat. It is highly disabling.
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Risk factors: short summary (n = 356 musicians with dystonia) : Classical musicians: 84 % Males: 78 % Young: start prior age 40 85 % Soloists: 51 % Certain instruments: Guitar>Piano>Flute Speed and accuracy of movements Anxiety and exaggerated perfectionism Unfavourable biomechanics, chronic pain, “fine motor load” Genetics (35% of musicians) Late start of training
N= 356, Lee et al. in preparation 2013
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Elbert T, Candia V, Altenmüller E. et al. NeuroReport 1998 9: 3571-3575 Münte TF, Altenmüller E, Jähnke, L, Nat. Neurosc. Rev. 2002, 3: 473-478
Blurring of sensory-motor “representations” in the brain may be one possible cause of focal dystonia
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Blurring of sensory-motor “representations” in the brain may be due to lack of lateral inhibition
Inhibition is crucial for motor control
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Blurring of sensory-motor “representations” in the brain may be due to lack of lateral inhibition
Effects of plasticity
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Treatment of Musicians� Dystonia
Pedagogical Retraining, e.g. L. Boullet, R. Fogel, H. Wind
Ergonomic Adaptations
Pharmacology
Botox- Injections
Electrophysiological Stimulation
Sensorimotor Retuning e.g. V. Candia, J. Roset y Llobet
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Outlook: Controlled Trial with THC (Dr. med. Andre Lee)
Substance used:
Sativex ®: - THC and Cannabidiol (CBD)
- Oromucosal application
- Tincture of cannabis plant
- Admitted for spasticity (in Multiple Scler.)
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Before THC
30 minutes after intake
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Predisposition (genetics) Deficit in Inhibition Dystonia
Perfectionism Anxiety Obsessive-Compulsive Behaviour
Pain, Abnormal Sensory Input
Temporo-Spatial Constraints
Social Constraints
A heuristic model on the genesis of musicians� dystonia
Intrinsic Triggering Factors Extrinsic Triggering Factors
Over-training
Unfavorable Biomechanics
Modified from Altenmüller and Jabusch: J. Neurol. 2010
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Predisposition (genetics) Deficit in Inhibition Dystonia
Perfectionism Anxiety Obsessive-Compulsive Behaviour
Pain, Abnormal Sensory Input
Temporo-Spatial Constraints
Social Constraints
Consequences for prevention
Intrinsic Triggering Factors Extrinsic Triggering Factors
Over-training Wrong Technique
Unfavorable Biomechanics
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1. The facts – student`s complaints
2. The means - institutions and programs 3. The contents - How to practice?
4. The consequences – Prevention of Dystonia
5. Summary and Outlook
Structure
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Teaching activities
Outpatient Clinic
Research programs
Prevention
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Eine berufsbegleitende Weiterbildung
DGfMM
Tel. (030) 3185-2580 www.kurt-singer-institut.de
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