Probing the neural dynamics of musicians' and non-musicians' consonant/dissonant perception: Joint analyses of electrical encephalogram (EEG) and functional magnetic resonance imaging (fMRI).

The perception of two (or more) simultaneous musical notes, depending on their pitch interval(s), could be broadly categorized as consonant or dissonant. Previous literature has suggested that musicians and non-musicians adopt different strategies when discerning music intervals: while musicians rely on the frequency ratios between the two fundamental frequencies, such as "perfect fifth" (3:2) as consonant and "tritone" (45:32) as dissonant intervals; non-musicians may rely on the presence of 'roughness' or 'beats', generated by the difference of fundamental frequencies, as the key elements of 'dissonance'. The separate Event-Related Potential (ERP) differences in N1 and P2 along the midline electrodes provided evidence congruent with such 'separate reliances'. To replicate and to extend, in this study we reran the previous experiment, and separately collected fMRI data of the same protocol (with sparse sampling modifications). The behavioral and EEG results largely corresponded to our previous finding. The fMRI results, with the joint analyses by univariate, psycho-physiological interaction, and representational similarity analysis (RSA) approaches, further reinforce the involvement of central midline-related brain regions, such as ventromedial prefrontal and dorsal anterior cingulate cortex, in consonant/dissonance judgments. The final spatiotemporal searchlight RSA provided convincing evidence that the medial prefrontal cortex, along with the bilateral superior temporal cortex, is the joint locus of midline N1 and dorsal anterior cingulate cortex for the P2 effect (for musicians). Together, these analyses reaffirm that musicians rely more on experience-driven knowledge for consonance/dissonance perception; but also demonstrate the advantages of multiple analyses in constraining the findings from both EEG and fMRI.

Peripheral nerve injuries in the performing artist.

Dancers and musicians have unique physical demands that can lead to injury of the peripheral nerves. Specific dance movements and specific instrument positions, combined with countless hours of practice and repetition, create an environment for potential nerve injury. Familiarity with these variables and recognition of the common presentations of neuropathic syndromes are essential in the evaluation of a performing artist with a suspected peripheral nerve injury. Assessment should include an understanding and analysis of their dance style or instrument playing posture, particularly in the position or motion that recreates the symptoms if possible. Practice and performance schedules should also be considered. Diagnosis may require electrodiagnostic testing, imaging, or diagnostic injections. Treatment should be comprehensive and may include modifications in practice schedule, posture/position, and technique in addition to consideration of medications, splints/orthoses, physical therapy, and injections. The instructor/teacher should be involved in the treatment plan if applicable. Complete rest in this population may not be realistic or necessary. Early and accurate diagnosis of nerve injury is important for safe return to dance or instrumental music.

Prevalence of musculoskeletal pain and associated factors among professional orchestra musicians in Norway.

BACKGROUND: Orchestra musicians have a high risk of experiencing musculoskeletal problems. These problems may lead to sleep and psychological disturbance. OBJECTIVES: This study investigated the occurrence of musculoskeletal pain (MSP) among orchestra musicians and the coherence between pain and predictors such as gender, age and instrument. Further, the impact of pain on sleep and mental health was analysed to assess pain as a predictor threatening musicians' wellbeing. METHODS: Some 358 musicians in eight different professional orchestras in Norway completed a questionnaire. Questions about pain experienced within the last 30 days were based on a national survey. Standardised screening tools like the Hopkins Symptom Checklist-25 (HSCL-25) and Bergen Insomnia Scale (BIS) were used to assess psychological distress and sleeping problems. Kruskal-Wallis tests were used to analyse the differences in the pain-related variables: experienced pain severity (EPS), number of pain areas, and work being perceived as the source of pain based on age. Mann-Whitney U tests were conducted to evaluate the statistical significance between gender and the pain-related variables. Spearman's rank correlations were used to examine the relationship between EPS and BIS, HSCL-25 and pain area. Additionally, simple linear regression models were employed to determine whether EPS can predict higher scores on the HSCL-25 and BIS scales. RESULTS: The prevalence of MSP experienced in the last 30 days among orchestra musicians in Norway was 85%. Musicians experienced frequent pain regardless of their gender, age or instrument group. Neck, shoulders and upper back represented the most reported pain areas. Further, it was observed that increased EPS was correlated with an increase in the number of pain areas and in work being perceived as the source of pain. EPS significantly predicted sleep- and psychological distress. CONCLUSIONS: Orchestra musicians have a high risk of encountering MSP. Furthermore, their psychological distress and sleeping problems seem to be related to experienced MSP. To deliver optimal health, these problems should be handled simultaneously.

Factors associated with psychological distress of workers in the Finnish Evangelical Lutheran Church.

BACKGROUND: The work of church employees contains many elements causing symptoms of stress and anxiety. They can lead into psychological distress and possibly indicate the beginning of a more serious psychological state. Women seem to be more disposed to psychological stress than men. We investigated factors contributing to psychological distress among women and men in four professions of the Evangelical Lutheran Church of Finland (ELCF). METHODS: A link to an electronic survey was sent to the members of respective trade unions of four professions of the ELCF, and we got responses from pastors (n = 241), church musicians (n = 92), diaconal workers (n = 85) and youth workers (n = 56). Psychological distress was assessed using the Mental Health Inventory-5 (MHI-5; cut-off value ≤ 52 indicating severe distress). We used logistic regression to examine sociodemographic, health-related, and work-related factors that could potentially be associated with psychological distress. RESULTS: We found severe psychological distress in all profession groups. Gender differences were scarce. Loneliness was the most important factor associated with psychological distress in both men and women (OR 14.01; 95% CI 2.68-73.25 and OR 7.84; 3.44-17.88, respectively), and among pastors and church musicians (OR 8.10; 2.83-23.16 and OR 24.36; 2.78-213.72, respectively). High mental strain of work was associated with distress in women (OR 2.45; 1.01-5.97). Good work satisfaction was a protective factor for men and women (OR 0.06; 95% CI 0.01-0.40 and OR 0.61; 0.18-0.40, respectively) and for pastors and church musicians (OR 0.22; 0.08-0.73 and OR 0.06; 0.01-0.43, respectively). For women, additional protective factors were being a pastor (OR 0.26; 0.07-0.95), or youth worker (OR 0.08; 0.01-0.48), and good self-reported health (OR 0.38; 0.18-0.82). CONCLUSION: Even though we found some protective factors, the share of workers with severe distress was higher in all profession groups of the ELCF than in the general population. Loneliness was the strongest stressor among both genders and high mental strain among women. The result may reflect unconscious mental strain or subordination to the prevailing working conditions. More attention should be paid to the mental wellbeing and work conditions of church employees.

An overview of rehabilitation approaches for focal hand dystonia in musicians: A scoping review.

OBJECTIVE: To provide a comprehensive overview of rehabilitation treatment strategies for focal hand dystonia (FHD) in musicians, examining their evolution and effectiveness. DATA SOURCES: A systematic search of five databases, PubMed, PEDro, Cochrane Library, Trip, and Google Scholar, to identify relevant articles on FHD rehabilitation. The last search was performed on 20 December 2023. METHODS: Inclusion criteria were applied to 190 initially identified articles, resulting in 17 articles for review. Exclusions were made for duplicates, irrelevant titles, abstracts, and non-rehabilitation interventions. RESULTS: Ten different rehabilitation approaches were identified over 20 years. While no definitive intervention protocol exists, a multimodal approach is commonly recommended. CONCLUSIONS: This scoping review underscores the diversity of rehabilitation strategies for FHD. It suggests the potential of multimodal approaches, emphasizing the need for further large-scale clinical efficacy studies.

Allergic contact dermatitis to woods of the genus Dalbergia in musical instruments.

BACKGROUND: The woods of trees of the genus Dalbergia are a frequent cause of allergic contact dermatitis. OBJECTIVES: To describe the different patterns of symptoms and sensitisation to woods of the genus Dalbergia in four patients whose regular work is linked to music, either as performers (two patients) or instrument makers. RESULTS: The patients showed extensive cross-reactivity between the different Dalbergia woods. The two musicians exhibited symptoms exclusively in the contact areas, while the instrument makers showed a pattern of airborne symptoms. The period from sensitisation to the development of symptoms varied greatly among the patients. CONCLUSIONS: The symptoms of allergic contact dermatitis to Dalbergia woods differ markedly depending on the route of contact. Cross-reactivity between the woods of this genus is very wide. The sensitising potential varies between the various Dalbergia woods, which require different contact periods depending on their sensitising power.

Muscle fatigue during assisted violin performance.

Muscle fatigue is a primary risk factor in developing musculoskeletal disorders, which affect up to 93% musicians, especially violinists. Devices providing dynamic assistive support (DAS) to the violin-holding arm can lessen fatigue. The objective was to assess DAS effects on electromyography median frequency and joint kinematics during a fatiguing violin-playing task. Fifteen university-level and professional violinists were equipped with electromyography sensors and reflective markers to record upper-body muscle activity and kinematics. They played G scales with and without DAS until exhaustion. Paired t-tests assessed DAS effects on delta (final-initial) electromyography median frequencies and joint kinematics. DAS prevented the median frequency decrease of left supraspinatus, superior trapezius, and right medial deltoid, and increases in trunk rotation, left-wrist abduction, and right arm-elevation plane. DAS effects on kinematics were marginal due to retention of musical performance despite fatigue. However, DAS reduced fatigue of several muscles, which is promising for injury prevention.Practitioner summary: Violinists are greatly affected by musculoskeletal disorders. Effects of a mobility assistive device on muscle fatigue during violin playing was investigated. The assistive technology slowed down the development of fatigue for three neck/shoulder muscles, making assisted musical performance a promising avenue to prevent violinists' injuries.

Live music in the intensive care unit-A mixed-methods pilot study exploring the experience and impact of live music played for the adult intensive care patient.

BACKGROUND: Evidence for music's beneficial effect on physical and mental disorders is mounting. Intensive care unit (ICU) patients experience multiple uncomfortable symptoms, which may be alleviated using a music-based intervention. Few studies have examined the experience and the physical impact of patient-tailored live music offered by trained health musicians in an adult ICU. AIMS: This study aimed to explore the experience of live music in adult patients admitted to an ICU, focusing on its effects on relaxation, stress, and pain. STUDY DESIGN: A pilot study with a convergent mixed-methods design. A total of 27 intensive care patients at a Danish University Hospital were offered patient-tailored live music by trained musicians in a single-session design. We performed participant observation and conducted patient interviews using an observational and semistructured interview guide. These data were supported by quantitative pre-post measurements of heart rate, respiration rate, mean arterial blood pressure, subjective pain experience, and heart-rate variability. The study was conducted from February 2020 to December 2021. FINDINGS: Using a Ricoeur-inspired analysis of observations and interviews, we elicited four themes: 'A break where you can swim away and relax', 'The living presence makes the play unique', 'Happy memories of the past and longing for home', and 'An intense and meaningful experience'. The quantitative analysis showed a significant decrease in heart rate (4.33 bpm, p < 0.02), respiration rate (2.93, p < 0.001), and blood pressure (3.30, p < 0.05) and a significant increase in heart-rate variation (-0.22, p < 0.01). Seven patients reported pain reduction after the music intervention, corresponding to a 24% reduction. CONCLUSION: Live music contributes to meaningful moments by bringing elements of everyday life into the ICU and may promote relaxation and reduce stress and pain. RELEVANCE TO CLINICAL PRACTICE: Our findings indicate that live music is a nonpharmacological experience that creates meaningful moments for critically ill patients.

Off the Beats and Track: Finding Historical Lesbian and Queer Women's Feminist Spaces through Musicians' Tour Schedules, Concert Flyers, and Correspondence.

This article explores historical research methods used to locate lesbians and queer women, especially within American and Canadian contexts from the 1960s onward. It begins by discussing methods such as analyzing women's and lesbian travel guides, directories, maps, periodicals, newsletters, newspapers, websites, oral histories, social media, archival fonds and collections. In particular, this article explores how utilizing lesbian and queer women musicians' tour schedules, calendars, correspondence, and contracts for shows and appearances can be a valuable historical research method, especially for locating impermanent historical lesbian and queer women's spaces off the beaten track. The article focuses on the Alix Dobkin Papers as a case study to explore aspects of historical lesbian and queer women's spaces and demonstrate the utility of this historical research method beyond Dobkin. The papers of Alix Dobkin include business correspondence, fan mail, fliers and programs from concerts, subject files, t-shirts, photographs, and memorabilia. As Dobkin played an important role in the women's music movement and toured regularly, her papers provide useful insight into historical debates about lesbian anti-racist politics, ethical consumption, community organizing, and transgender inclusion and exclusion.

Interviews with musicians with hearing aids.

Objectives: Musicians who wear hearing aids are a unique subset of hearing-impaired individuals. There are a number of issues musicians experience with hearing aids, making effective hearing rehabilitation a challenge. Research suggests hearing aid satisfaction in musicians is lower partly due to their advanced listening skills, however, qualitative research addressing musicians who wear hearing aids for music is scarce. The current study aimed to record the barriers encountered by musicians who wear hearing aids when playing their instrument/singing, listening to recorded music and listening to live music.Design: Professional musicians who wear hearing aids were interviewed. Participants were questioned about their experiences with hearing loss and hearing aids, with particular emphasis on experiences listening to recorded and live music, and playing or performing music with the hearing aids.Study Sample: Eight professional musicians were interviewed, using a semi-structured interview style, with a question and prompt guide.Results: Thematic analysis revealed three main themes in the data: the musicians' journey, communication, and flexibility/adjustability.Conclusions: The results have implications for future research into specific fitting parameters for hearing aids for musicians (particularly for music performance), the need for evidence-based rehabilitation programs for musicians with hearing loss, and the need for a glossary of terms to assist communication between Audiologists and musicians.

[Mapping the musician brain during awake craniotomy]. / Kartirovanie muzykal'nykh tsentrov golovnogo mozga vo vremya kraniotomii v soznanii.

Direct cortical stimulation during awake craniotomy with speech testing became the «gold standard¼ in brain mapping and preserving speech zones during neurosurgical procedures. However, there are many other cerebral functions, and their loss can be very critical for certain patients. For example, such a function is production and perception of music for musicians. This review presents the latest data on functional anatomy of musician brain, as well as aspects of neurosurgical treatment with awake craniotomy and music testing under brain mapping.

Aberrant Cerebello-Cortical Connectivity in Pianists With Focal Task-Specific Dystonia.

Musician's dystonia is a type of focal task-specific dystonia (FTSD) characterized by abnormal muscle hypercontraction and loss of fine motor control specifically during instrument playing. Although the neuropathophysiology of musician's dystonia remains unclear, it has been suggested that maladaptive functional abnormalities in subcortical and cortical regions may be involved. Here, we hypothesized that aberrant effective connectivity between the cerebellum (subcortical) and motor/somatosensory cortex may underlie the neuropathophysiology of musician's dystonia. Using functional magnetic resonance imaging, we measured the brain activity of 30 pianists with or without FTSD as they played a magnetic resonance imaging-compatible piano-like keyboard, which elicited dystonic symptoms in many but not all pianists with FTSD. Pianists with FTSD showed greater activation of the right cerebellum during the task than healthy pianists. Furthermore, patients who reported dystonic symptoms during the task demonstrated greater cerebellar activation than those who did not, establishing a link between cerebellar activity and overt dystonic symptoms. Using multivoxel pattern analysis, moreover, we found that dystonic and healthy pianists differed in the task-related effective connectivity between the right cerebellum and left premotor/somatosensory cortex. The present study indicates that abnormal cerebellar activity and cerebello-cortical connectivity may underlie the pathophysiology of FTSD in musicians.

Dystonia in Performing Artists: Beyond Focal Hand Dystonia.

Overuse of specific muscles in perfecting movements in performing arts makes an artist prone to many medical conditions. Musicians' hand dystonia is focal task-specific dystonia (FTSD) of hand among musicians that has been extensively studied. However, embouchure, lower limbs, and laryngeal muscles can also be affected among musicians. Embouchure dystonia (ED) refers to dystonia of the perioral and facial muscles that occurs in musicians while playing embouchure instruments. It is essential to identify ED since the dystonia might become persistent and non-task-specific if the musician continues to play the instrument. Task-specific dystonia of lower limbs among musicians has been exclusively reported among drummers. The diagnosis rests on electromyogram (EMG) of the involved muscles during the task. Singer's dystonia (SD) refers to task-specific laryngeal dystonia that occurs only while singing. The diagnosis of SD is based on laryngeal EMG and spectrographic analysis. Cortical hyperexcitability, loss of inhibition, and aberrant plasticity are central to the pathogenesis in both ED and musicians' hand dystonia. The pathophysiological studies in SD are limited. This review aims to discuss the lesser known dystonias among performing artists - ED, FTSD of lower limb, and SD.

Cancer incidence among musicians: 45 years of follow-up in four Nordic countries.

BACKGROUND: There are studies suggesting that participation in musical activities may protect from cancer. On the other hand, some musicians have a lifestyle that might increase the risk of cancer. The objective of this study was to assess the cancer pattern of musicians in four Nordic countries. MATERIAL AND METHODS: This study combines census and cancer registry data from 1961 to 2005 for 13 million people from Finland, Iceland, Norway, and Sweden. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for entire national populations used as reference rates. RESULTS: There were 11,401 male and 3105 female musicians with 2039 cancer cases. The SIR for all sites combined was 1.02 (95% confidence interval 0.97-1.07) in men and 1.04 (0.94-1.15) in women. In male musicians, there were statistically significant excesses in oropharyngeal cancer (4.36, 2.73-6.60), esophageal cancer (2.08, 1.51-2.81), liver cancer (1.81, 1.26-2.52), and skin melanoma (1.40, 1.10-1.75). The risk was decreased in lip cancer (0.13, 0.02-0.48), stomach cancer (0.66, 0.50-0.82), and lung cancer (0.77, 0.65-0.90). In female musicians, there were no statistically significant SIRs in any of the cancer types studied, but the risk of breast cancer was significantly elevated in the age category of 70+ (1.52, 1.04-2.15). The overall SIR was stable over the 45 year period of observation, but strong decreases were observed in the SIRs of esophageal cancer, liver cancer, laryngeal cancer, and skin melanoma. CONCLUSION: Musicians have characteristics of indoor workers such as low incidence of lip cancer and high incidence of skin melanoma. The low incidence of lung cancer suggests that the prevalence of smoking among musicians is lower than in the general population while the elevated risk of alcohol-related cancer types suggest that drinking is likely more common among musicians. The cancer risk for all sites combined is still similar to that of the general population in the four countries studied.

A qualitative study exploring the implementation determinants of rehabilitation and global wellness programs for orchestral musicians.

OBJECTIVE: To explore the facilitators and barriers to implementation of a pilot workplace rehabilitation and global wellness program for orchestral musicians. DESIGN: Qualitative study comprising focus groups and interviews.Setting: Workplace of conservatory and orchestral musicians and administrators. PARTICIPANTS: Musicians, administrators and a conductor from two professional orchestras; tertiary-level orchestral students and an administrator from a conservatory of music. INTERVENTIONS: We held four focus groups and two interviews to document the perspectives of the participants concerning the implementation determinants of a pilot workplace rehabilitation and wellness program (exercises and health-related education). Meetings consisted of questions based on the Consolidated Framework for Implementation Research. Thematic content analysis was conducted using this same framework, with subcoding according to the Theoretical Domains Framework. RESULTS: Fourteen musicians and five administrators participated. Results suggest that the implementation determinants for the pilot and future programs rely mainly on the Inner Setting, that is, what musicians refer to as 'the music world', specifically cultural elements such as pain beliefs (e.g. no pain no gain) and lack of resources and time (barriers). Characteristics of Individuals such as social influences amongst colleagues and beliefs about the consequences of self-care or lack thereof, and Intervention Characteristics such as complexity can be facilitators or barriers. All emerging themes have an undercurrent that lies in the Inner Setting. CONCLUSION: Musicians' culture, currently a barrier, is a crucial determinant of rehabilitation and wellness program implementation in the orchestral musicians' workplace. A focus on musicians' workplace environment is necessary to optimise implementation and intervention impacts.

Assessment of occupational personal sound exposures for music instructors.

Daily activities performed by music instructors generate high sound levels that could potentially lead to overexposure. Adverse outcomes associated with high-exposure to sound, such as hearing loss and tinnitus, can be especially devastating to music instructors as hearing is essential to both job performance and career reward. The primary objective of this study was to compare sound exposures of music instructors to recommended exposure limits. Secondary objectives were to identify high-exposure activities and to evaluate potential similar exposure groups by examining between- and within-worker exposure variability. Personal sound exposure measurements from music instructors were collected using dosimeters during full workdays for up to 4 weeks over multiple semesters at a university's school of music. Study participants completed an activity log to record work-related activities throughout each day of sampling. Dosimeters logged 1-sec sound equivalent levels in A-weighted decibels. These data were used to calculate 8-hr time-weighted averages, daily dose, and activity-specific contributions to that dose to determine if daily exposures exceeded the recommended limit of 85 dBA and to identify high-exposure activities that could be targeted for future intervention. Seventeen participants were sampled for a total of 200 days. Approximately one-third of daily exposures exceeded recommended limits. The groups with the highest exposures were brass and conducting instructors. Conductors experienced the highest between-day variability in daily exposures. Activities that contributed the most to daily dose included group rehearsals, personal practice sessions, and performances, while classes and administrative work did not substantially contribute to daily dose. Daily exposures were highly variable, ranging from 60-95 dBA (mean = 81 dBA, sd = 8 dBA), and were influenced by instructional area and musical activity. Future exposure assessments for music instructors should include sampling for multiple days, and those above-recommended limits should be placed into hearing conservation programs.

Leveraging implementation science to prevent and reduce musculoskeletal overuse injury in musicians: A proposal for the study of a conceptual framework.

BACKGROUND: Musician health and wellness, a fundamental requirement for safe, effective and optimal musical performance, is not guaranteed. Performance related musculoskeletal disorders (PRMD) affect between 60% and 90% of all musicians, and have serious consequences on musculoskeletal health, performance ability and the overall healthcare burden of musculoskeletal injury. The high prevalence of PRMD in musicians can be prevented and reduced via health-education programs designed to address risk factors and practice habits. Multiple studies demonstrate the efficacy of education and instructional exercises in reducing PRMD symptoms in musicians. Despite the awareness of risk and the substantial consequence of non-adherence, implementation of health-education programs is complex and challenging and is rarely offered in music institutions. For successful adoption of musculoskeletal health programs, it is important to identify system level barriers and facilitators and it is important to develop and pilot effective strategies to guide successful implementation of musculoskeletal health programs for musicians. PURPOSE: This paper proposes a conceptual framework using implementation science methodology to study the factors that influence adoption of musician health education programs to prevent performance related injury. The overall goal of this methodology is to identify determinants of implementation by engaging key stakeholders, developing strategies for adoption of injury prevention programs and generate hypotheses for future studies. METHODS: The research plan is designed to accomplish the specific aims of this study. Through a mixed-method study we will use qualitative and quantitative methods to address potential barriers, and design and test implementation feasibility of health-education programs for musicians. RESULTS/CONCLUSIONS: Our findings will inform the development of a large-scale participant randomized hybrid trial to assess effectiveness and implementation outcomes of health education programs and ultimately reduce injury and promote musculoskeletal longevity and performance in musicians.

A musician-centered approach to management of performance-related upper musculoskeletal injuries.

STUDY DESIGN: Invited Clinical Commentary BACKGROUND: Performance related musculoskeletal disorders (PRMD) are common in instrumental musicians and often affect the upper extremities. These overuse injuries typically result from inadequate attention to the musculoskeletal demands required for the high-level performance of musician-students and experienced instrumentalists.1 PRMDs often interfere with career trajectory, and in extreme cases, can be career ending. Many clinicians and healthcare practitioners treating upper extremity injuries are not familiar with the specific demands faced by instrumental musicians and how to tailor treatment and prevention strategies to the specific risks and occupational needs of each instrumental group. PURPOSE OF THE STUDY: This paper describes an evidenced-based framework for the assessment, prevention, and treatment of musculoskeletal musician injuries to provide clinicians with an instrument-specific, and musician-centered guide for practice. We synthesized available literature on instrumental ergonomics, biomechanical demands, and upper extremity injuries to highlight the risks and common upper-extremity pathologies, focusing on the specific demands of instrumental groups: piano, high strings (violin and viola), low strings (cello and bass), percussion, woodwinds, and brass. Targeted assessment, prevention, and treatment strategies are reviewed in this context to provide healthcare providers with an evidence-based framework to approach the treatment of PRMD to mitigate incidence of injury during practice and performance. METHODS: A comprehensive search of electronic databases was conducted including all study designs. RESULTS: This review describes risk factors for PRMD in instrumental musicians, strategies to prevent misuse and performance injury, and musician-centered interventions to allow playing while reducing risk of misuse. CONCLUSION: The suggested assessment and treatment framework can assist clinicians with a customized patient-centered approach to prevention and treatment by addressing the gap in clinical knowledge with the goal of ultimately reducing the incidence and severity of PRMD in musicians.

Feasibility and impact of a musculoskeletal health for musicians (MHM) program for musician students: A randomized controlled pilot study.

BACKGROUND: There is a high incidence of performance-related musculoskeletal disorders in musicians that may be reduced via education programs. However, the efficacy of formalized injury prevention programs has not been rigorously studied. PURPOSE: To assess the feasibility and effect of a formalized injury prevention education workshop on incidence and severity of musculoskeletal pain in a cohort of musician-students attending an intensive summer music festival compared to controls. STUDY DESIGN: Randomized-controlled-pilot trial. METHODS: Musicians at an 8-week long intensive summer festival were randomized to an intervention (workshop) or control group. Workshop attendees participated in a 90-minute session of injury prevention strategies. Musculoskeletal outcome data were collected at the start and end of the festival. Outcomes included presence of musculoskeletal pain, adherence level, and sub-scales of the Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians. RESULTS: A total of 57 musician-students (ages 17-30, 23 females) participated in the study, and 48(84%) completed the study. Seventy-five percent of workshop participants reported adherence over 8 weeks. At baseline, 84% of participants reported a history of playing-related pain, and 47% recent or current pain. Participants played a range of instruments (50% string, 34% piano, 16% woodwind/brass). At baseline, average weekly reported playing time was 39 hours (±11). At follow-up, reported pain decreased by 32% in the intervention group and increased by 8% in controls (P < .01). Pain interference scores were lower (Post - Pre = -4.58, 95% CI -9.26 to 0.11, P = .055). There was no statistically significant difference between groups for pain intensity. CONCLUSIONS: The high compliance and willingness to participate suggests that injury prevention education implementation is feasible. Our preliminary findings suggest a positive effect on pain incidence and pain interference in the intervention group. Future studies will examine the relationship between adherence levels and injury rates in a larger cohort and identify obstacles to implementation.

Ecology of musical performance as a model for evaluation and treatment of a musician with a playing related musculoskeletal disorder: A case report.

STUDY DESIGN: Case report BACKGROUND: Musicians with playing related musculoskeletal disorders (PRMD) require complex decision making to interpret examination findings and develop a holistic treatment approach that considers the unique interaction with their instrument. The Ecology of Musical Performance (EMP) model is a novel comprehensive clinical model designed to provide guidance for musician-centered evaluation, goal setting, and intervention planning for musicians with PRMD. PURPOSE OF THE STUDY: To describe the application of EMP in the evaluation and treatment of a pianist with PRMD. METHODS: Clinical documentation and the patient's symptom logs provided data for this study. Special considerations unique to musicians in the initial evaluation as well as a timeline of interventions are presented to illustrate the application of the EMP model for a holistic approach to treatment. RESULTS AND DISCUSSION: The pianist showed an increase in grip strength and self-reported hand function both in daily activities and in piano performance and training. Pain free practice tolerance increased and the patient successfully returned to participation in piano training and performance. CONCLUSION: This case demonstrates how a treatment program can be customized to benefit musicians taking into consideration the complexity introduced by their relationship with music making as a primary meaningful occupation. EMP may support a person-centered approach to musicians with PRMD by aligning with the phenomenology of musical performance and facilitating collaborative goal setting and problem solving.