9~?Altenmuller, E.2003^Focal dystonia: advances in brain imaging and understanding of fine motor control in musicians 523-38, xi Hand Clin193qBiomechanics Brain/anatomy & histology/physiology Dystonia/*physiopathology Electroencephalography Hand/*physiopathology Humans Magnetic Resonance Imaging Magnetoencephalography Motor Skills *Music Neuronal Plasticity/*physiology Occupational Diseases/*physiopathology Research Support, Non-U.S. Gov't Somatosensory Cortex/*physiopathology Tomography, Emission-ComputedAugThis article reviews the neuroanatomic and neurophysiologic foundations of music performance and learning. Music performance is regarded as complex voluntary sensorimotor behavior that becomes automated during extensive practice with auditory feedback. It involves all motor, somatosensory, and auditory areas of the brain. Because of the life-long plasticity of neuronal connections, practicing a musical instrument results first in a temporary and later in a stable increase in the amount of nerve tissue devoted to various component tasks. Motor and somatosensory brain regions corresponding to specific subtasks of music performance are larger in musicians starting younger than age 10 years than in the general population. In rare cases, overuse of movement patterns may induce a degradation of motor memory that results in a loss of voluntary control of movements, called musician's cramp. Specific therapeutic options for this condition are reviewed.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12945651 10749-0712 Journal Article Review Review, Tutorial12945651University for Music and Drama, Hannover Institute for Music Physiology and Musicians' Medicine, Hohenzollernstr. 47, Hannover D-30161, Germany. altenmueller@hmt-hannover.de 6~?UAydin, K. Ciftci, K. Terzibasioglu, E. Ozkan, M. Demirtas, A. Sencer, S. Minareci, O.2005lQuantitative proton MR spectroscopic findings of cortical reorganization in the auditory cortex of musicians128-36AJNR Am J Neuroradiol261Adult Aged Aspartic Acid/*analogs & derivatives/metabolism Auditory Cortex/*anatomy & histology Cerebral Cortex/*anatomy & histology Choline/metabolism Creatine/metabolism Dominance, Cerebral/physiology Energy Metabolism/*physiology Female Humans *Image Processing, Computer-Assisted *Magnetic Resonance Imaging *Magnetic Resonance Spectroscopy Male Middle Aged *Music Neuronal Plasticity/*physiology Phantoms, Imaging Reference Values Temporal Lobe/anatomy & histologyJan_BACKGROUND AND PURPOSE: Brain has a capacity for reorganization that enables use-dependent adaptations to acquire skills. Previous studies demonstrated morphometric and functional use-dependent changes in the brains of musicians. The purpose of this study was to investigate the differences in metabolite concentrations in the planum temporale, an area strongly associated with the processing of music perception, between trained musicians and non-musicians. We hypothesized that the microscopic changes leading to use-dependent adaptations in brain might cause neurometabolite changes that could be detected with quantitative proton MR spectroscopy. METHODS: We performed quantitative proton MR spectroscopy in the left planum temporale of 10 musicians (six men and four women; age range, 20-37 years) and in those of 10 age- and sex-matched control subjects who had no musical training. We calculated the major metabolite concentrations in the left planum temporale. RESULTS: The difference in N-acetylaspartate (NAA) concentrations between the musicians and the non-musician control subjects was statistically significant (P <.01). No significant difference was noted in the choline and creatine concentrations between the musicians and the non-musician control subjects (P >.05). The NAA concentration of the musicians correlated with the total duration of musical training and activity (r=0.733, P <.05). CONCLUSION: Long-term, professional musical activity caused significant changes in the neurometabolite concentrations that might reflect the physiologic mechanism(s) of use-dependent adaptation in the brains of musicians.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15661714 0195-6108 Journal Article15661714`Department of Radiology, Istanbul Medical School, Istanbul University, Istanbul, Etiler, Turkey.~?Gaser, C. Schlaug, G.2003:Gray matter differences between musicians and nonmusicians514-7Ann N Y Acad Sci999|Brain/*physiology Comparative Study Human Magnetic Resonance Imaging Male *Music Neuronal Plasticity/*physiology OccupationsNov Musicians learn complex motor and auditory skills at an early age and practice these specialized skills extensively from childhood through their entire careers. Using a voxel-by-voxel morphometric technique, we found gray matter volume differences in motor as well as auditory and visuospatial brain regions comparing professional musicians (keyboard players) with matched amateur musicians and nonmusicians. These multiregional differences might represent structural adaptations in response to long-term skill learning and repetitive rehearsal of these skills. This is supported by finding a strong association between structural differences, musician status, and practice intensity as well as by a wealth of supporting animal data showing structural changes in response to long-term motor training.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=146811750077-8923 Journal Article14681175<Department of Psychiatry, University of Jena, Jena, Germany.~?(Nelson, M. D. Wilson, R. H. Kornhass, S.2003_Performance of musicians and nonmusicians on dichotic chords, dichotic CVs, and dichotic digits536-44J Am Acad Audiol1410Adolescent Adult Auditory Perception/*physiology Comparative Study *Dichotic Listening Tests/methods Dominance, Cerebral Female Humans Male Mental Recall/physiology Middle Aged *Music Research Support, U.S. Gov't, Non-P.H.S.DecPPerception of dichotic chords (free recall and directed recall), nonsense syllables (CVs), and three-pair digits was assessed on 24 musicians and 24 nonmusicians. On the dichotic-CV and dichotic-digit free-recall tasks, there was a significant right-ear advantage, but there were no group differences. With the dichotic-chords, free-recall condition, a significant left-ear advantage was observed but no group difference. For the dichotic-chords, directed-recall conditions, the musicians performed significantly better by 10 percent than the nonmusicians. Unexpectedly, for the dichotic chords, the 62-72 percent correct performances were better on the free-recall condition than the 42-55 percent performances on the directed-recall conditions. These differences between the two response modes were attributed to the difficulty of the dichotic-chord listening tasks and the probabilities associated with the closed-set response paradigms. The findings suggest that the dichotic-chord paradigm used in this study should not be included in clinical protocols used to assess auditory perceptual abilities.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14748550 1050-0545 Journal Article14748550nCentral Michigan University, Department of Communication Disorder, Mt. Pleasant 48859, USA. nelso1md@cmich.edu?GAckermann, B. Adams, R.2003@Physical characteristics and pain patterns of skilled violinists65-71&Medical Problems of Performing Artists182gThis study evaluated the association between upper body physical measurements of skilled violin players and the presence and location of pain related to playing their instruments. To cover a range of playing styles and teaching backgrounds, volunteers were recruited from universities and orchestras. A group of 32 instrumentalists participated in this study and had their upper limb lengths and ranges of motion measured by a physiotherapist. Between-limb range comparisons revealed some significantly greater range measurements of the left hand compared with the right, which arc hypothesized to represent an adaptation to years of instrument playing. Participants also completed questionnaires detailing the location and duration of any performance-related pains. Regression results identified physical attributes that may be risk factors in the development of pain problems in violin players with shorter arms. An implication of these findings is that players with right arms shorter than those of their peers may need to pay attention to the positioning of their head on the instrument and to overall instrument placement._Practice Director, Capital Clinic Physiotherapy, Canberra, Australia; ackermann@netspeed.com.au~? Amadio, P. C.2003 Surgical assessment of musicians 241-5, vi Hand Clin192zHand Injuries/etiology/*surgery Humans *Music Occupational Diseases/etiology/*surgery Physical Examination Risk AssessmentMayThe art and science of medicine are called into action at a high level when one evaluates and treats the impaired hand of a skilled musician. A surgeon who is conscientious and understanding of the patient and the patient's needs and who is capable of assessing correctly the anatomic and physiologic pathology is most likely to make the proper decision in advising for or against a surgical component of the overall treatment plan.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12852666 10749-0712 Journal Article Review Review, Tutorial12852666Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. pamadio@mayo.edu N~?(Byl, N. N. Nagajaran, S. McKenzie, A. L.2003wEffect of sensory discrimination training on structure and function in patients with focal hand dystonia: a case series1505-14Arch Phys Med Rehabil8410Adult Comparative Study Cumulative Trauma Disorders/etiology/physiopathology/rehabilitation Dystonia/etiology/physiopathology/rehabilitation Dystonic Disorders/etiology/physiopathology/*rehabilitation Evoked Potentials, Somatosensory Exercise Therapy/*methods Female Hand/*physiopathology Humans Motor Skills/physiology *Music Occupational Diseases/etiology/physiopathology/rehabilitation Perception/*physiology Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Treatment OutcomeOctKOBJECTIVE: To measure the effects of sensorimotor training based on the principles of neuroplasticity for patients with focal hand dystonia. DESIGN: Case series of 3 subjects with focal hand dystonia of the left hand, compared with age-matched normative controls. SETTING: Outpatient clinic. PARTICIPANTS: Three consecutive clinic patients-musicians with focal hand dystonia-who described a history of repetitive practice and performance (2 women; ages, 23 y and 35 y; 1 man; age, 24 y). INTERVENTION: Subjects were asked to stop performing the tasks that caused the abnormal movements, to participate in a wellness program (aerobics, postural exercises, stress free hand use), and to carry out supervised, attended, individualized, repetitive sensorimotor training activities at least once week for 12 weeks and reinforced daily at home. MAIN OUTCOME MEASURES: Standard tests documenting somatosensory hand representation, target-specific hand control, and clinical function. RESULTS: On the affected side, the 3 subjects improved an average of 86.8% on somatosensory hand representation, 117% on target-specific performance, 23.9% on fine motor skills, 22.7% on sensory discrimination, 31.9% on musculoskeletal skills, and 32.3% on independence. All 3 subjects improved 10% or more on 90% of the subtests with 20% improvement on 50% of the subtests. CONCLUSION: Individuals with focal hand dystonia who have a history of repetitive hand use can improve cortical somatosensory responses and clinical motor function after individualized sensorimotor training consistent with the principles of neural adaptation.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14586919 0003-9993 Journal Article14586919Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of California, San Francisco, USA. byl@itsa.ucsf.edut?gKim, Y.2005Combined treatment of improvisation and desensitization to alleviate music performance anxiety in female college pianists: a pilot study17-24&Medical Problems of Performing Artists201This study examined the effect of a Music Therapy Improvisation and Desensitization Protocol (MTIDP) on ameliorating music performance anxiety of female college pianists. Six participants served as their own controls and participated in (1) a baseline assessment (pretest); (2) six weekly sessions that involved rhythmic breathing exercises, free improvisation, and desensitization exercises; and (3) a final evaluation (posttest). Measures of the Likert Anxiety Scale, Spielberger[inverted question mark]s State[inverted question mark]Trait Anxiety Inventory, and the Performance Anxiety Response Questionnaire were obtained before and after the series of MTIDP sessions. A Wilcoxon matched-pairs signed-ranks test was computed to determine whether the data were significantly different from the pretest to the posttest. Results indicated that there were significant differences in the Likert Anxiety Scale and Spielberger[inverted question mark]s State Anxiety Inventory. No clear trends were found in the Trait Anxiety Inventory. Although not significant, the mean for the Performance Anxiety Response Questionnaire in the posttest (M = 78.50) was lower than it was in the pretest (M = 74.67).wGraduate School of Music Thrapy, 53-12, Chungpa-dong 2 Ga, Yongsan-Gu, Seoul 140-742, South Korea; ysk@sookmyung.ac.kr.~? Bigand, E.2003AMore about the musical expertise of musically untrained listeners304-12Ann N Y Acad Sci999]Auditory Perception/*physiology Brain/*physiology Comparative Study Humans *Music OccupationsNovSeveral behavioral experiments that were designed to compare the abilities of musicians and nonmusicians to process subtle changes in musical structures are surveyed. These experiments deal with different aspects of music perception including the processing of melodic and harmonic structures, the processing of large-scale structures, and implicit learning. In all these experiments, the so-called nonmusician listeners behaved in a very similar way as did highly trained students from music conservatories and music departments. This outcome suggests that when the experimental setting requires participants to process musical structures (in contrast to musical tones), the large audience of untrained listeners exhibits sophisticated musical abilities that are similar to those of musical experts. It has been suggested that musically untrained listeners are "experienced listeners" who use the same principles as musical experts in organizing their hearing of music.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14681154 0077-8923 Journal Article Review14681154Laboratoire d'Etude de l'Apprentissage et du Developpement, UMR 5022, Universite de Bourgogne, Dijon, France. bigand@u-bourgogne.frs~? _Vuust, P. Pallesen, K. J. Bailey, C. van Zuijen, T. L. Gjedde, A. Roepstorff, A. Ostergaard, L.2005To musicians, the message is in the meter pre-attentive neuronal responses to incongruent rhythm are left-lateralized in musicians560-4 Neuroimage242*Acoustic Stimulation Brain/anatomy & histology/*physiology Brain Mapping/*methods Chronobiology Communication Humans *Music Reproducibility of ResultsJan 15Musicians exchange non-verbal cues as messages when they play together. This is particularly true in music with a sketchy outline. Jazz musicians receive and interpret the cues when performance parts from a regular pattern of rhythm, suggesting that they enjoy a highly developed sensitivity to subtle deviations of rhythm. We demonstrate that pre-attentive brain responses recorded with magnetoencephalography to rhythmic incongruence are left-lateralized in expert jazz musicians and right-lateralized in musically inept non-musicians. The left-lateralization of the pre-attentive responses suggests functional adaptation of the brain to a task of communication, which is much like that of language.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15627598 1053-8119 Journal Article15627598fCentre for Functionally Integrative Neuroscience, University of Aarhus, Aarhus, Denmark. pv@pet.auh.dk/~? 8Winspur, I. Arcier, A. F. Blum, J. Brandfonbrener, A. G.2003HAppendix: national organizations involved with medical care of musicians343-53 Hand Clin192Europe Humans *Music Occupational Diseases/etiology/*therapy Societies, Medical/*organization & administration Specialties, Medical/*organization & administration United StatesMayfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12852677 0749-0712 Journal Article12852677-Hand Clinic, London, England, United Kingdom.~? (Jabusch, H. C. Vauth, H. Altenmuller, E.2004AQuantification of focal dystonia in pianists using scale analysis171-80 Mov Disord192Adult Botulinum Toxin Type A/therapeutic use Disability Evaluation Dystonic Disorders/classification/*diagnosis/drug therapy Female *Hand Humans Injections, Intramuscular Male *Motor Skills/classification/drug effects *Music *Neurologic Examination/drug effects/statistics & numerical data Occupational Diseases/classification/*diagnosis/drug therapy Reference Values Reproducibility of ResultsFebFocal dystonia in pianists is a task-specific movement disorder that causes loss of pianistic skills and provokes irregularities in playing. So far, no method has been available for objective quantification of the disorder. Eight professional pianists with focal dystonia and eight healthy professional pianists matched by age, gender, and handedness were examined, using a newly developed MIDI-based Scale Analysis as well as the Arm Dystonia Disability Scale (ADDS). Key velocities and timing parameters were analyzed. In 5 pianists with dystonia, follow-up examinations were carried out after treatment with botulinum toxin-A. In affected hands, significantly higher mean standard deviations of timing parameters were seen compared with healthy reference hands. After treatment with botulinum toxin-A, significant improvements in performance parameters were monitored by Scale Analysis. Mean standard deviations of inter-onset intervals correlated with ADDS scores. We conclude that Scale Analysis is an effective and precise tool for quantification of focal dystonia in pianists and provides fine resolution. It is independent of rating methods and allows reliable follow-up examinations during treatment.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14978672 0885-3185 Journal Article14978672gUniversity of Music and Drama, Institute of Music Physiology and Musicians' Medicine, Hanover, Germany.~~? Wills, G. I.2003UForty lives in the bebop business: mental health in a group of eminent jazz musicians255-9Br J Psychiatry1835Anxiety Disorders/epidemiology Biography Creativeness Family Humans Male Mental Disorders/*epidemiology Mood Disorders/epidemiology *Music Personality Disorders/epidemiology Psychotic Disorders/epidemiology Schizophrenia/epidemiology Substance-Related Disorders/epidemiology Suicide United States/epidemiologySepBACKGROUND: Above-average levels of psychopathology have been demonstrated convincingly in groups of outstanding individuals working in the arts. Currently, jazz musicians have not been studied in this regard. AIMS: To investigate any evidence of psychopathology in a group of eminent jazz musicians. METHOD: Biographical material relating to 40 eminent American modern jazz musicians was reviewed and an attempt was made to formulate diagnoses using DSM-IV. RESULTS: Evidence was provided of levels of psychopathology in the sample of jazz musicians similar to those found in other previously investigated creative groups, with the exception of substance related problems. An interesting connection between creativity and sensation-seeking was highlighted. CONCLUSIONS: The link between psychopathology and creativity in the arts was given further weight. Future studies of jazz musicians using larger samples and making comparison with groups from different eras of music would give greater clarification to this area.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12949000 0007-1250 Journal Article12949000gwils@btopenworld.com~? Parry, C. B.2003&Prevention of musicians' hand problems 317-24, vii Hand Clin192Dystonic Disorders/etiology/*prevention & control Hand Injuries/etiology/*prevention & control *Health Knowledge, Attitudes, Practice Humans Joint Instability/etiology/*prevention & control *Music Occupational Diseases/etiology/*prevention & controlMayA significant proportion of musicians suffer musculoskeletal problems as a result of playing their instruments. The author describes the British Performing Arts Medicine Trust founded by Dr. Ian James 12 years ago to address these problems in Great Britain. The author, a rheumatologist consultant since its inception, reviews over a thousand cases seen at these clinics. Almost half of these patients had no obvious structural abnormality sustaining symptoms through poor posture, bad practice techniques, unfitness and overuse. Lack of full rehabilitation after injury was the most common cause of structural disorders. The responsibilities for prevention of injuries is described for the three components of the profession: musicians, teachers, and administrators.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12852674 10749-0712 Journal Article Review Review, Tutorial12852674uBritish Performing Arts Medicine Trust, 196 Shaftesbury Avenue, London WC2N 8JF, United Kingdom. bpamt@dial.pipex.com~? Winspur, I.2003_Advances in objective assessment of hand function and outcome assessment of the musician's hand483-93 Hand Clin193Disability Evaluation Hand Injuries/diagnosis/*physiopathology/surgery Humans Musculoskeletal Diseases/diagnosis/*physiopathology/surgery *Music Occupational Diseases/diagnosis/*physiopathology/surgery *Outcome Assessment (Health Care) Physical ExaminationAugDoctors have made great strides in the past 20 years in the analysis of musicians' medical problems; we realize they suffer the same medical conditions as the general population but the manifestations may be different and hence the diagnosis more difficult; we realize that many of the conditions glibly attributed to overuse and repetition are no more common in this group than the general public engaged in much less repetitive activity; we realize that many of musicians' symptoms may not represent inflammation or injury but are a manifestation of misuse or mismatch to the instrument and of fatigue; we realize many of these symptoms may be related to technical problems alone; we realize that as a group musicians respond well to appropriate care and that surgery does not inevitably end a musician's career. To diagnose and treat this group properly requires a complete and full analysis of the musician, the interface, and the instrument from the outset. Anything less produces an incorrect or incomplete analysis and the poor results that have bedeviled musicians' medical care to date. Such analysis requires a basic understanding of musicians' problems, detailed knowledge of many of the specific syndromes they suffer, and time for a complete and thorough assessment. It is this lack of time and the lack of facilities to examine the musician while playing that currently causes the greatest number of mistakes in the medical care of this unique and demanding group of individuals.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12945646 10749-0712 Journal Article Review Review, Tutorial12945646]The Hand Clinic, 30 Devonshire Street, London W1N 1RF, England. devonshireconsult@yahoo.co.uk ~~?LBarbe, M. F. Barr, A. E. Gorzelany, I. Amin, M. Gaughan, J. P. Safadi, F. F.2003Chronic repetitive reaching and grasping results in decreased motor performance and widespread tissue responses in a rat model of MSD167-76 J Orthop Res211Animals Behavior, Animal Cumulative Trauma Disorders/immunology/*physiopathology Disease Models, Animal Female Hand Strength/*physiology Interleukin-1/blood Macrophages/immunology Motor Skills/physiology Musculoskeletal Diseases/immunology/*physiopathology Rats Rats, Sprague-Dawley Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. Tendon Injuries/immunology/physiopathology Tendons/immunology/physiopathologyJanThis study investigated changes in motor skills and tissues of the upper extremity (UE) with regard to injury and inflammatory reactions resulting from performance of a voluntary forelimb repetitive reaching and grasping task in rats. Rats reached for food at a rate of 4 reaches/min, 2 h/day, and 3 days/week for up to 8 weeks during which reach rate, task duration and movement strategies were observed. UE tissues were collected bilaterally at weekly time points of 3-8 weeks and examined for morphological changes. Serum was tested for levels of interleukin-1alpha (IL-1) protein. The macrophage-specific antibody, ED1, was used to identify infiltrating macrophages and the ED2 antibody was used to identify resident macrophages. Rats were unable to maintain baseline reach rate in weeks 5 and 6 of task performance. Alternative patterns of movement emerged. Fraying of tendon fibrils was observed after 6 weeks in the mid-forelimb. After 4 weeks, a general elevation of ED1-IR macrophages were seen in all tissues examined bilaterally including the contralateral, uninvolved forelimb and hindlimbs. Significantly more resident macrophages were seen at 6 and 8 weeks in the reach limb. At 8 weeks, serum levels of IL-1alpha increased significantly above week 0. Our results demonstrate that performance of repetitive tasks elicits motor decrements, signs of injury and a cellular and tissue responses associated with inflammation.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=125075950736-0266 Journal Article12507595Department of Physical Therapy, College of Allied Health Professions, Temple University, 3307 North Broad Street, Philadelphia, PA 19140, USA. mbarbe@temple.edu~?%Barr, A. E. Barbe, M. F. Clark, B. D.2004jSystemic inflammatory mediators contribute to widespread effects in work-related musculoskeletal disorders135-42Exerc Sport Sci Rev324OctRecent studies in a rat model have indicated that the pathophysiological mechanisms underlying development of work-related musculoskeletal disorders (WMSDs) include widespread inflammation and subsequent fibrosis at high levels of repetition and force. A systemic inflammatory component may affect tissues not directly involved in task performance, thereby contributing to widespread and puzzling symptoms that are often characteristic of patients with WMSDs.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=156049310091-6331 Journal Article15604931wPhysical Therapy Department, College of Health Professions, Temple University, Philadelphia, PA, USA. aebarr@temple.edu~?Ehrle, N. Samson, S.2005cAuditory discrimination of anisochrony: Influence of the tempo and musical backgrounds of listeners133-147 Brain Cogn581JunjThis study explored the influence of several factors, physical and human, on anisochrony's thresholds measured with an adaptive two alternative forced choice paradigm. The effect of the number and duration of sounds on anisochrony discrimination was tested in the first experiment as well as potential interactions between each of these factors and tempo. In the second experiment, the tempo or the inter onset interval (IOI) was varied systematically between 80 and 1000ms. The results showed that just noticeable differences increase linearly and proportionally with IOI in accordance with Weber's law except for quickest tempo (IOI of 80ms). The third experiment investigated the role of musical training on anisochrony thresholds obtained for different IOI. It focused on differential effects of musical experiences by comparing non-musicians, instrumentalists, and percussionists thresholds. The results of the present study replicated the findings of previous experiments regarding the adequacy of Weber's law for slow rhythm and provided evidence for its departure for fast tempos. Moreover, thresholds from percussionists seem distinguishable from the ones of other listeners by their highest sensitivity to temporal shifts suggesting therefore the necessity to control the nature of musical experiences. The results are discussed according to current models of time perception.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15878734 0278-2626 Journal article15878734LHospital of Reims, University of Lille 3, 59653 Villeneneuve d'Ascq, France. ~?3Ragert, P. Schmidt, A. Altenmuller, E. Dinse, H. R.2004mSuperior tactile performance and learning in professional pianists: evidence for meta-plasticity in musicians473-8Eur J Neurosci192Adult Analysis of Variance Brain/*physiology Comparative Study Discrimination Learning/physiology Female Humans Learning/*physiology Male *Music Neuronal Plasticity/*physiology Research Support, Non-U.S. Gov't Touch/*physiologyJan!Musician's brains constitute an interesting model for neuroplasticity. Imaging studies demonstrated that sensorimotor cortical representations are altered in musicians, which was assumed to arise from the development of skilled performance. However, the perceptual consequences of the cortical changes remain elusive. Here we ask whether cortical reorganization induced by professional musical skill training is paralleled by the evolution of other, unrelated perceptual abilities. We therefore studied psychophysically tactile spatial acuity as an indirect marker of cortical changes in professional pianists and non-musician control subjects using a simultaneous two-point discrimination paradigm. We show that long-lasting piano practising resulted in lower spatial discrimination thresholds in comparison to non-musicians. In musicians, individual discrimination thresholds were linearly correlated with the daily training duration, indicating a direct link between tactile acuity and the degree of piano practising. To investigate whether the superior acuity in pianists is subject to further improvement, we used a Hebbian stimulation protocol of tactile coactivation known to improve spatial tactile acuity. Three hours of coactivation further reduced their discrimination thresholds. The coactivation-induced gain in pianists was significantly larger in comparison to control subjects and correlated with the years of heavy daily practising (>3 h/day), but not with the total years including casual playing. Our results suggest that despite already high-level performance in pianists, Hebbian learning was more effective in musicians than in controls. This implies stronger capacities for plastic reorganization and points to enhanced learning abilities implicating a form of meta-plasticity in professional pianists.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14725642 0953-816x Journal Article14725642Institute for Neuroinformatics, Theoretical Biology Ruhr-University, D-44780 Bochum, Germany. patrick.ragert@neuroinformatik.ruhr-uni-bochum.de?HHildebrandt, H. Nubling, M.2004Providing further training in musicophysiology to instrumental teachers: do their professional and preprofessional students derive any benefit?62-9&Medical Problems of Performing Artists192.The objective of this study was to establish whether instrumental teachers and their students would derive any benefit from advanced education and training in musicophysiologic theory and practice. It was hypothesized that this training would have a positive effect on the teaching styles of teachers and that the changes would be noticed by their pupils, who would improve their playing habits. Twenty-six instrumental teachers and 66 of their students (allocated to the test or the control group) participated in an evaluation that was to be assessed by means of standardized questionnaires. During a summer semester, teachers in the test group attended a 2-hour weekly course focusing on the sensory and psychomotor systems of musicians, whereas teachers in the control group were excluded from these courses. Based on a pre-to-post measurement, the teachers in the test group, in contrast to the teachers in the control group, noted that they had become more responsible for instructions and more precise related to playing movements. When compared with the control group, the student test group in retrospect noted a change in the teaching style of their teachers in verbal instructions and in guidance of posture and playing-related movements. These findings need to be confirmed with longer term and randomized studies.|Professor, Performing Arts Medicine Section, Winterhur Zurich Music Conservatory, Zurich, Switzerland; edu@h-hildebrandt.org"~?(Moore, D. G. Burland, K. Davidson, J. W.2003>The social context of musical success: a developmental account529-49 Br J Psychol94Pt 4Adolescent Adult Child *Child Development Environment Female Follow-Up Studies Humans Male Mother-Child Relations *Music *Social Behavior Task Performance and AnalysisNovThis paper brings together extensive data from 257 children to explore the relative importance of social-environmental factors during critical periods of children's musical development. The paper also presents preliminary findings from a follow-up of 20 of the most musically successful children 8 years later to determine which childhood factors predict differences in success as adult performers. Those children who continued to play an instrument started at an early age, had higher parental support in lessons, and had first teachers who were friendly but not too technically able. However, these factors alone were not sufficient to predict relative success in childhood. Successful childhood musicians also appear to need teachers who are 'not too relaxed' and also 'not too pushy' and they also need to do substantial amounts of practice. The follow-up study suggested, though, that successful adult performers were not those who did the most practice; rather, the successful adults were those who took part in more concert activities in childhood, did more improvisation, and who had mothers at home in their early years. The results are discussed in relation to theories of musical development and the changing influences of parents, teachers and peers.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14687460 0007-1269 Journal Article14687460LDepartment of Psychology, University of East London, UK. d.g.moore@uel.ac.uk ~?:Laitinen, H. M. Toppila, E. M. Olkinuora, P. S. Kuisma, K.20039Sound exposure among the Finnish National Opera personnel177-82Appl Occup Environ Hyg183Environmental Monitoring/*methods Finland Humans *Music Occupational Exposure/*analysis *Sound/adverse effects Tinnitus/etiologyMarThe purpose of the study was to determine how and when the personnel of the Finnish National Opera are exposed to noise and whether exposure depends on musical selection of repertoire. Additionally, an evaluation of sound exposure level due to individual rehearsals was included. The measurements were done using individual noise dosimeters and fixed-point measurements. From the measurements, annual noise exposure in the Opera was evaluated. The conductors, dancers, and double bass players were exposed to levels below 85 decibels, A-weighted, dB(A), which is the national action level. The choir members were exposed to sound levels of 92 and 94 dB(A). Within the orchestra, the highest sound exposure levels were found among percussionists, 95 dB(A); flute/piccolo players, 95 dB(A); and brass players, 92-94 dB(A). Other sound exposure levels among orchestra members varied from 83 to 89 dB(A). Soloists and rehearsal pianists are likely to be exposed to sound levels exceeding the national action level. From an exposure perspective, the individual rehearsals, 79-100 dB(A), proved to be as important as performances and group rehearsals, 82-99 dB(A), among orchestra musicians and choir singers. The ambient sound level for the lighting crew was 76 +/- 4 dB(A). However, the measured sound levels at the ear varied from 77 to 92 dB(A) due to the communication via headphones that had individual volume control. For the majority of personnel of the Finnish National Opera, sound exposure level exceeded the national action level value of 85 dB(A). Artists exceeded the action level during both individual and group rehearsals, as well as during performances. Hearing protection has been designed for musicians. Education/reinforcement is required to ensure it is worn.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12573963 1047-322x Journal Article12573963SDepartment of Physics, Finnish Institute of Occupational Health, Helsinki, Finland.d?VMarques, D.N. Rosset-Llobet, J. Marques, M.F.F. Gurgel, I.G.D. Augusto, L.G.S.20035Flamenco guitar as a risk factor for overuse syndrome11-4&Medical Problems of Performing Artists181The purpose of this study was to analyze the prevalence of overuse syndrome in classical and flamenco guitarists from Andalucia (Spain). Of the 64 professional guitarists who participated in the study, 75% showed symptoms of overuse syndrome. Considering the fact that classical and flamenco are two distinct styles of guitar playing, 62.5% of the classical guitarists who took part in the study were affected by some kind of overuse syndrome, versus 87.5% of the flamenco guitarists (p = 0.021). Among the guitarists affected by overuse syndrome, a total of 50% of the classical and 82.1% of the flamenco guitarists reported deterioration in their playing ability (p = 0.018). The specific symptom for which there was a difference in distribution in the two groups was tension in the upper extremities, reported more frequently by the flamenco guitarists. The higher incidence of problems and the greater perception of tension among the flamenco guitarists are attributed mainly to the plucking technique they use, which requires greater effort from the extensor muscles of the fingers, as well as the need to produce a higher volume of sound due to the nature of playing in groups. q?.Brandfonbrener, AG. Amadio, PC. Kalish, R.2004AArtsMedicine Master Class. Thumb pain in an instrumental musician181-5&Medical Problems of Performing Artists194~? Chamagne, P.20030Functional dystonia in musicians: rehabilitation309-16 Hand Clin192Arm/physiopathology Dystonic Disorders/diagnosis/*physiopathology/*rehabilitation Hand/*physiopathology Humans *Music Neurologic Examination Physical Examination Physical Therapy Techniques/*methods Posture/physiology Shoulder/physiopathology Spine/physiopathologyMayFor functional dystonia in musicians, rehabilitation should be principally psychomotor, including psychotherapy based on analysis of the personality and a global physical education of the corporal scheme--it is a compartmental reeducation. From the time of onset, it is of great importance to the musician that the mechanism at the origin of the problem be understood and analyzed. For the therapist, the principal goal is to identify the multiple compensations that mask the real dysfunction. When the musician and the therapist agree on the real cause of the dystonia, it becomes evident that an anatomopathologic explanation using simple vocabulary is as efficacious in the treatment as is the physical therapy. Beginning to rectify abnormal postures and reeducation of the impaired motions then can begin with a whole range of techniques, using specific exercises, stretching, and removable ortheses.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12852673 10749-0712 Journal Article Review Review, Tutorial12852673JCentre de Reeducation du Musicien, Paris, France. marcpapillon@hotmail.comX?GAckermann, B.J. Adams, R.2004Interobserver reliability of general practice physiotherapists in rating aspects of the movement patterns of skilled violinists3-11&Medical Problems of Performing Artists191In the music medicine literature, experienced clinicians recommend the visual observation of musicians performing on their instruments to identify movement patterns that potentially increase the risk of an injury. Visual assessment of functional task performance is a skill used clinically by many health care professionals to enhance decision-making regarding the best management and treatment strategies for a particular client. Little research exists, however, to identify whether consistent movement patterns would be identified during such a procedure and whether there are particular injury risk features that can be identified reliably by a group of practitioners. This study asked a group of experienced clinical physiotherapists to rate movement patterns of 30 skilled violinists performing a violin-playing task to evaluate whether similar scores would result. Results indicated that these therapists varied widely in their rating methods, and interrater reliability scores ranged from mostly poor to fair. These scores occurred regardless of the presence or absence of playing-related injuries in the violinists. A small sample of available intrarater scores showed better consistency, although still not of high reliability. Further research may indicate whether physiotherapists or health care practitioners experienced in observing a complex task such as violin playing would show greater interrater reliability in using such a scoring system. kDirector, Capital Clinic Physiotherapy and Musicphysio, Canberra, ACT, Australia; ackermann@netspeed.com.au~?Bendor, D. Wang, X.2005?The neuronal representation of pitch in primate auditory cortex1161-5Nature4367054Aug 25Pitch perception is critical for identifying and segregating auditory objects, especially in the context of music and speech. The perception of pitch is not unique to humans and has been experimentally demonstrated in several animal species. Pitch is the subjective attribute of a sound's fundamental frequency (f(0)) that is determined by both the temporal regularity and average repetition rate of its acoustic waveform. Spectrally dissimilar sounds can have the same pitch if they share a common f(0). Even when the acoustic energy at f(0) is removed ('missing fundamental') the same pitch is still perceived. Despite its importance for hearing, how pitch is represented in the cerebral cortex is unknown. Here we show the existence of neurons in the auditory cortex of marmoset monkeys that respond to both pure tones and missing fundamental harmonic complex sounds with the same f(0), providing a neural correlate for pitch constancy. These pitch-selective neurons are located in a restricted low-frequency cortical region near the anterolateral border of the primary auditory cortex, and is consistent with the location of a pitch-selective area identified in recent imaging studies in humans.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16121182 1476-4687 Journal Article16121182Laboratory of Auditory Neurophysiology, Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21025, USA. dbendor@bme.jhu.edu~?Bentivoglio, M.2003JMusical skills and neural functions. The legacy of the brains of musicians234-43Ann N Y Acad Sci999Brain Creativeness *Famous Persons History, 18th Century History, 19th Century History, 20th Century History, Medieval Humans Music/*history Neuroanatomy/*history Phrenology/*historyNovAn overview of the history of debates on the correlation of musical skills with neurological functions in health and disease is presented. Selected biographical sketches of composers (Hildegard von Bingen, Mozart, Donizetti, Mussorgsky, and Ravel), whose neurological disease may have influenced musical creativity, are discussed. The search for information on the localization of skills in the brains of musicians is reviewed. The relation of mental ability to brain structure is a prominent theme in the history of neuroscience, and the effort to localize musical skills dates back to the excesses of phrenology in the early nineteenth century. The phrenological tables included an "organ of music" among the sites subserving intellectual capabilities, mapped on the basis of palpation of the head bumps. Since the second half of the nineteenth century, when the study of brain physiology, anatomy, and pathology had a remarkable development and impact on the neurosciences, structural features of the brain, particularly the cerebral cortex, of individuals with peculiar talents, including musical skills, have been examined to search for clues on the localization of mental phenomena. These studies, which continued in the twentieth century, are currently difficult to validate in view of the rigor imposed by current scientific standards. However, the issue of localization of functions in the musical brain is still debated and is now at the forefront of the neurosciences, exploiting especially functional neuroimaging. The historical overview of these problems is certainly exemplary of progress of knowledge, but also warns against excessive "localizationist" efforts.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14681147 ,0077-8923 Historical Article Journal Article14681147uDepartment of Morphological and Biomedical Sciences, University of Verona, Verona, Italy. marina.bentivoglio@univr.it?h(Burkholder, K. R. Brandfonbrener, A.G.2004KPerformance-related injuries among student musicians at a speciality clinic116-22&Medical Problems of Performing Artists193'The purpose of this study was to determine the relative frequency of performance-related injuries in patients age 18 and younger who presented to a specialized performing arts clinic. A total of 314 student musicians age 18 and younger were seen at the specialty clinic between its inception in 1985 and November 2002. Retrospective chart review and analysis of the resulting data were conducted. Information collected included presenting complaint, problem location, and diagnosis. Data were analyzed with respect to gender, instrument played, and ligamentous laxity. The upper extremity was the most common injury location. The lateralization and anatomic location of the injuries were influenced by the instrument played. The most frequent problems were musculoskeletal pain syndrome and excessive muscle tension. Lack of physical conditioning and poor instrumental technique also were commonly noted. Ligamentous laxity of the wrist and fingers was found in a proportion higher than in that of the general population and was related to the number and the type of physical diagnoses made. Laxity was more common in girls. Other diagnoses that were more frequent among female musicians included lack of conditioning, intrinsic hand muscle weakness, and scoliosis. In boys, carpal tunnel syndrome and tendinitis were more common. The findings suggest that young age is not a protective factor against playing-related injuries. Physicians caring for musicians in this age group should have an awareness of the problems and risk factors related to playing musical instruments.Faculty Development Fellow, UIC-Illinois Masonic Medical Center Family Practice Residency Program, Chicago, IL; musicmd@ameritech.net.~?9Candia, V. Wienbruch, C. Elbert, T. Rockstroh, B. Ray, W.2003mEffective behavioral treatment of focal hand dystonia in musicians alters somatosensory cortical organization7942-6Proc Natl Acad Sci U S A10013.Behavior Therapy Brain Mapping Dystonic Disorders/*therapy Fingers Hand Hand Injuries/*therapy Human Immobilization Motor Cortex/anatomy & histology Movement Disorders/*therapy Music Occupational Exposure Somatosensory Cortex/*anatomy & histology/physiology Splints Support, Non-U.S. Gov't Time FactorsJun 24New perspectives in neurorehabilitation suggest that behavioral treatments of movement disorders may modify the functional organization of central somatosensory neural networks. On the basis of the assumption that use-dependent reorganization in these networks contributes to the fundamental abnormalities seen in focal dystonia, we treated 10 affected musicians and measured the concomitant somatosensory changes by using whole-head magnetoencephalography. We found that effective treatment, using the method of sensory motor retuning, leads to alterations in the functional organization of the somatosensory cortex. Specifically, before treatment, somatosensory relationships of the individual fingers differ between the affected and unaffected hands, whereas after treatment, finger representations contralateral to the dystonic side become more similar to the less-affected side. Further, somatosensory finger representations are ordered more according to homuncular principles after treatment. In addition, the observed physiologic changes correlated with behavioral data. These results confirm that plastic changes in parallel with emergent neurological dysfunction may be reversed by context-specific, intensive training-based remediation.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=127713830027-8424 Journal Article12771383tDepartment of Psychology, University of Konstanz, Fach D25, D-78457 Konstanz, Germany. Victor.Candia@Uni-Konstanz.de=~? Winspur, I.2003-Special operative considerations in musicians 247-58, vi Hand Clin192.Finger Joint/physiopathology/surgery Hand/anatomy & histology Hand Injuries/etiology/rehabilitation/*surgery Humans *Music Nerve Compression Syndromes/etiology/surgery Occupational Diseases/etiology/rehabilitation/*surgery *Suture Techniques Tennis Elbow/etiology/surgery Tenosynovitis/etiology/surgeryMayMusicians are a unique group, requiring digital control and skills at the highest levels. Each instrument has its own special needs and the musician must be seen in the context of the instrument played. Surgery also must be seen in this context. The special areas of modification of technique and some of the more commonsurgical situations encountered in musicians are considered in this article.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12852667 10749-0712 Journal Article Review Review, Tutorial12852667ZHand Clinic, 30 Devonshire Street, London, W1G 6PU, England. devonshireconsult@yahoo.co.uk ~? KBarr, A. E. Safadi, F. F. Gorzelany, I. Amin, M. Popoff, S. N. Barbe, M. F.2003gRepetitive, negligible force reaching in rats induces pathological overloading of upper extremity bones2023-32J Bone Miner Res1811Animals Bone Diseases/immunology/*pathology/*physiopathology Bone and Bones/immunology/pathology/physiopathology Cumulative Trauma Disorders/immunology/*pathology/*physiopathology Disease Models, Animal Immunohistochemistry Inflammation/immunology/pathology Macrophages/cytology/immunology Osteoclasts/cytology/physiology Rats Rats, Sprague-Dawley Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S. Time Factors Upper Extremity/*physiopathologyNov Work-related repetitive motion disorders are costly. Immunohistochemical changes in bones resulting from repetitive reaching and grasping in 17 rats were examined. After 3-6 weeks, numbers of ED1+ macrophages and osteoclasts increased at periosteal surfaces of sites of muscle and interosseous membrane attachment and metaphyses of reach and nonreach forelimbs. These findings indicate pathological overloading leading to inflammation and subsequent bone resorption. INTRODUCTION: Sixty-five percent of all occupational illnesses in U.S. private industry are attributed to musculoskeletal disorders arising from the performance of repeated motion, yet the precise mechanisms of tissue pathophysiology have yet to be determined for work-related musculoskeletal disorders. This study investigates changes in upper extremity bone tissues resulting from performance of a voluntary highly repetitive, negligible force reaching and grasping task in rats. MATERIALS AND METHODS: Seventeen rats reached an average of 8.3 times/minute for 45-mg food pellets for 2 h/day, 3 days/week for up to 12 weeks. Seven rats served as normal or trained controls. Radius, ulna, humerus, and scapula were collected bilaterally as follows: radius and ulna at 0, 3, 4, 5, 6, and 12 weeks and humerus and scapula at 0, 4, and 6 weeks. Bones were examined for ED1-immunoreactive mononuclear cells and osteoclasts. Double-labeling immunohistochemistry was performed for ED1 (monocyte/macrophage lineage cell marker) and TRACP (osteoclast marker) to confirm that ED1+ multinucleated cells were osteoclasts. Differences in the number of ED1+ cells over time were analyzed by ANOVA. RESULTS: Between 3 and 6 weeks of task performance, the number of ED1+ mononuclear cells and osteoclasts increased significantly at the periosteal surfaces of the distal radius and ulna of the reach and nonreach limbs compared with control rats. These cells also increased at periosteal surfaces of humerus and scapula of both forelimbs by 4-6 weeks. These cellular increases were greatest at muscle attachments and metaphyseal regions, but they were also present at some interosseous membrane attachments. The number of ED1+ cells decreased to control levels in radius and ulna by 12 weeks. CONCLUSIONS: Increases in ED1+ mononuclear cells and osteoclasts indicate that highly repetitive, negligible force reaching causes pathological overloading of bone leading to inflammation and osteolysis of periosteal bone tissues.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=146065160884-0431 Journal Article14606516Department of Physical Therapy, College of Health Professions, Temple University, Philadelphia, Pennsylvania 19140, USA. aebarr@temple.edu 8?!HShan, G. Visentin, 2003 P.2003QA quantitative three-dimensional analysis of arm kinematics in violin performance3-10&Medical Problems of Performing Artists181Overuse syndrome (OS) resulting from repetitive motion affects a significant percentage of performing musicians. Particularly susceptible to OS, violinists use different kinds of muscle control patterns in the right and left limbs and must assume a complex asymmetrical posture to hold and play the instrument. There is a clear need for developing efficient and effective strategies to prevent OS in violinists, keeping biological loads under physiological limits and focusing on physical economy during training. The first step in developing such strategies requires quantitative kinematic description of the motions involved in violin performance. This study supplies such information for the arms and violin bow. The motions of eight professional violinists and three University music students were captured using a ninecamera VICON V&i motion capture system. Each performed a fundamental control skill employing all four strings of the violin. The data were analyzed using quantitati! ve model comparison and statistical analysis. The results of this study show parameters such as elbow height normalized by body height and shoulder and elbow joint motion to have highly consistent patterns between the subjects. Wrist control patterns varied widely. Playing on different strings influences right arm patterns significantly, but not left. This is the first study providing quantitative 3-D kinematic data on shoulders, elbows, wrists, and how. It provides a foundation for further exploration of the kinematic characteristics of violin performance, for the examination of the potential causes of OS, and for an evaluation of practices that might minimize injuries.Assistant Professor (Biomechanics), Department of Kinesiology, University of Lethbridge, 4401 University Drive, Lethbridge, Alberta, Canada T1K 3M4; g.shan@uleth.ca~?"=Warren, J. D. Uppenkamp, S. Patterson, R. D. Griffiths, T. D.2003;Separating pitch chroma and pitch height in the human brain10038-42Proc Natl Acad Sci U S A10017Acoustic Stimulation Adult Auditory Cortex/anatomy & histology/physiology Brain/anatomy & histology/*physiology Female Humans Magnetic Resonance Imaging Male Pitch Perception/*physiology Research Support, Non-U.S. Gov'tAug 19Musicians recognize pitch as having two dimensions. On the keyboard, these are illustrated by the octave and the cycle of notes within the octave. In perception, these dimensions are referred to as pitch height and pitch chroma, respectively. Pitch chroma provides a basis for presenting acoustic patterns (melodies) that do not depend on the particular sound source. In contrast, pitch height provides a basis for segregation of notes into streams to separate sound sources. This paper reports a functional magnetic resonance experiment designed to search for distinct mappings of these two types of pitch change in the human brain. The results show that chroma change is specifically represented anterior to primary auditory cortex, whereas height change is specifically represented posterior to primary auditory cortex. We propose that tracking of acoustic information streams occurs in anterior auditory areas, whereas the segregation of sound objects (a crucial aspect of auditory scene analysis) depends on posterior areas.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12909719 0027-8424 Journal Article12909719gWellcome Department of Imaging Neuroscience, Institute of Neurology, Queen Square, London WCIN 3BG, UK.R~?#Zatorre, R. McGill, J.2005 Music, the food of neuroscience?312-5Nature4347031'Acoustic Stimulation Adolescent Auditory Cortex/physiology Auditory Perception/*physiology Child Cognition/physiology Emotions/physiology Humans Infant Infant, Newborn Memory/physiology *Music Neuronal Plasticity/physiology Neurosciences/*trends Pitch Discrimination/physiology Speech/physiologyMar 17fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15772648 1476-4687 Journal Article15772648 Montreal Neurological Institute. r?$G Schwab, B. Schultze-Florey, A.2004:Velopharyngeal insufficiency in woodwind and brass players21-5&Medical Problems of Performing Artists191Vetopharyngeal insufficiency (VPI) has received little attention in the medical literature. The aim of the present study was to determine the extent to which VPI constitutes a problem for woodwind and brass musicians. A total of 148 musicians (professionals from a symphony orchestra and students, the latter mainly from a national youth orchestra) were asked if they were aware of the phenomenon of VPI and whether they experienced it. Intraoral pressure measurements were performed to determine pressure peaks, mean pressure, and maximum attainable pressures. Of the 148 musicians, 81 were aware of the VPI disorder, and 24 of them showed symptoms of it themselves. Six of the affected musicians reported that VPI occurred in association with colds or stress or the playing of extremely high notes. One musician noted that it occurred only on return from vacation leave. Of the symptom-free musicians, 15% reported that they noticed symptoms of VPI during their musical training but that these gradually dissipated of their own accord. VPI in woodwind and brass instrumentalists is obviously more common than previously recognized. Despite reports in the medical literature that predominantly young musicians are affected, in our study only 47% of the individuals with symptoms were school pupils or music students (who overall constituted 41% of the study subjects). Oboists and clarinettists were the most frequently affected, perhaps because they develop relatively high mean pressures. Although VPI frequently occurs when woodwind and brass musicians are undergoing training and then regresses, it may persist, particularly in instrumentalists in whom high mean pressures form. To prevent persistent VPI, it seems advisable for music teachers to perform pressure measurements during instructional periods.dDepartment of Otolaryngology, Medical University of Hannover, Germany; schwab.burkard@mh-hannover.de~?%6White, J. W. Hayes, M. G. Jamieson, G. G. Pilowsky, I.2003`A search for the pathophysiology of the nonspecific "occupational overuse syndrome" in musicians331-41 Hand Clin192Algorithms Cumulative Trauma Disorders/*diagnosis/etiology/*physiopathology Humans *Music Occupational Diseases/etiology/*physiopathology TerminologyMayXThe findings of this investigation have suggested a new theory to help explain the origin of activity-related pain. It proposes an as yet unrecognized physiologic process (the physiologic activity limitation process). When the intensity of an activity is greater than that appropriate for an individual's level of fitness for that activity, this process then generates unpleasant sensations, physiologic activity-related pain, the function of which is to limit that activity. The physiologic pain generated by this process will have pathways in common with pain caused by other protective mechanisms.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12852676 10749-0712 Journal Article Review Review, Tutorial12852676Department of Orthopaedic Surgery, Barking, Havering & Red Bridge Hospitals NHS Trust, Oldchurch Hospital, Romford, Essex RM70BE, United Kingdom. Dr.JWhite@ashna.net~?&Ackermann, B. J. Adams, R. D.2004dPerceptions of causes of performance-related injuries by music health experts and injured violinists669-78Percept Mot Skills992Adolescent Adult Female *Health Personnel Humans Male Middle Aged *Music *Occupational Diseases *Perception *Professional Competence Questionnaires *Wounds and InjuriesOct^Skilled violin and viola players, all of whom had a current performance-related musculoskeletal injury, were asked to report their perceptions of contributing risk factors, consistent with a participatory ergonomics approach. The 26 players, age 18 to 60 years, had been playing for a minimum of 10 years and averaged three hours of practice per day. In addition, 7 music health experts, all with more than 10 years of clinical experience in treating musicians, were asked to report on the risk factors for musicians' performance-related injuries. A high correlation between the perceptions of these two groups was found, with the same top five factors in terms of severity indicated by both groups. Factors rated as high risk were primarily intrinsic and related to the manner in which respondents practiced, to playing posture, and to flaws in skill technique.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15560359 0031-5125 Journal Article15560359GSchool of Physiotherapy, University of Sydney. ackerman@netspeed.com.au B?'g Tubiana, R.2003DProlonged neuromuscular rehabilitation for musician's focal dystonia&Medical Problems of Performing Artists184aThe purpose of this study was to determine, through self-reporting techniques, the training and injury rates among students studying dance in the private sector. The private studio provides the major venue for students to study dance. This is especially true for young students (ages 8-18) who study ballet, jazz, and tap and who participate in dance competitions. A private dance studio is defined as a studio open to the community with no audition requirements for entry that teaches various technique styles. Private studio dancers are not training specifically to be professional dancers in major ballet companies. Few data exist regarding the training or injury rates of these students in part because of difficulties with access and compliance. To date, 3,700 surveys have been distributed (January 2001-present) to students training in private studios throughout California. Information was requested concerning current and past injuries, dance training history, and competition schedules. This ongoing investigation currently has examined 173 (male = 6 and female = 167) completed surveys. The mean age of dancers who responded to the survey was 15.2 years. Of the dancers surveyed, 93% study at private dance studios, and 67% have studied in high school dance programs. The number of injuries reported (n = 226) included fractures, strains, sprains, and tendonitis. The ankle, knee, and back were found to be the most frequent injury sites. Correlations between the number of different techniques studied and the total hours danced, the number of different techniques studied and number of injuries for each individual, and the number of injuries for each individual and total hours danced all were significant at 0.01. Initial results support that dancers in the private dance studio are susceptible to injuries similar to those experienced by dancers in elite training centers. iDepartment of Theatre and Dance, California State University, Fullerton, California; rkish@fullerton.edu. ~?)!Tyc, F. Boyadjian, A. Devanne, H.2005lMotor cortex plasticity induced by extensive training revealed by transcranial magnetic stimulation in human259-66Eur J Neurosci211VAdult Brain Mapping Comparative Study Electric Stimulation/*methods Electromyography/methods Evoked Potentials, Motor/radiation effects Female Humans Imaging, Three-Dimensional/methods Laterality/physiology *Magnetics Motor Cortex/*radiation effects Motor Skills/*physiology Muscle, Skeletal/*physiology Neuronal Plasticity/*radiation effectsJanThis study examines the effect of high-level skilled behaviour on motor cortex representations of upper extremity muscles of ten sportswomen. We used transcranial magnetic stimulation to map proximal medial deltoid and distal extensor carpi radialis muscle representations on both hemispheres during low-level voluntary contraction. We compared cortical representation areas between two groups of subjects and between hemispheres within subjects. The first group comprised five elite volleyball attackers and the second group five runners. Four stimuli were delivered on multiple scalp sites (1.5 cm apart) to induce motor-evoked potentials recorded by surface EMG. Maps were described in terms of excitable scalp positions and of motor-evoked potentials. We observed differences in map areas between the two groups. Volleyball players had larger cortical representations of the proximal medial deltoid muscle than runners. Furthermore, the volleyball players had larger map areas for dominant muscles compared with non-dominant muscles. There was no difference, however, in map area for either muscle between the dominant and non-dominant arm in the runner group. Our results show that heavy training in a specific skill induces an expansion of proximal muscle representation in the contralateral primary motor cortex. This enlarged map area for proximal muscle is accompanied by an increase in the overlapping of proximal and distal muscle representations. This could reflect the fact that motor learning of co-ordinated movement involves a common control of both muscles. This reorganization supports the hypothesis of a cortical plasticity driven by activity.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15654863 (0953-816x Clinical Trial Journal Article15654863hUniversite du Littoral-Cote d'Opale, 220 rue F. Buisson BP699, 62228 Calais Cedex, France. tycfr@free.fr~?* Zehr, E. P.2005ENeural control of rhythmic human movement: the common core hypothesis54-60Exerc Sport Sci Rev331Arm/physiology Canada Humans Leg/physiology *Movement *Neural Pathways Research Support, Non-U.S. Gov't Task Performance and AnalysisJanRhythmic motor patterns are ubiquitous in the animal kingdom. Walking, cycling, and swimming are examples of rhythmic locomotor tasks that humans perform routinely. This paper outlines the common core hypothesis that rhythmic motor patterns in human locomotion share common central neural control mechanisms. This is subserved by presumed central pattern generators that regulate arm and leg movements during locomotion.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15640722 10091-6331 Journal Article Review Review, Tutorial15640722Rehabilitation Neuroscience Laboratory, P.O Box 3010 STN CSC, A358 MacLaurin Building, University of Victoria, Victoria, British Columbia, Canada, V8W 3P1. pzehr@uvic.ca ~?+QCowles, A. Beatty, W. W. Nixon, S. J. Lutz, L. J. Paulk, J. Paulk, K. Ross, E. D.2003eMusical skill in dementia: a violinist presumed to have Alzheimer's disease learns to play a new song493-503 Neurocase96<Aged Aged, 80 and over Alzheimer Disease/*psychology Attention Dementia/*psychology Humans Language Learning/physiology Magnetic Resonance Imaging Male Memory Mental Recall Middle Aged *Music Neuropsychological Tests Psychomotor Performance/*physiology Recognition (Psychology)/physiology Space Perception/physiologyDecyPrevious studies have described patients with possible or probable Alzheimer's disease (AD) who continued to play familiar songs skillfully, despite their dementias. There are no reports about patients with dementia who successfully learned to play new songs, and two papers describe failures of patients with AD to learn to play a new song although they continued to play familiar songs competently. In the present paper we describe a moderately demented patient (SL) with probable AD who learned to play a song (Cossackaya!) on the violin that was published after the apparent onset of his dementia. He showed modest retention of the song at delays of 0 and 10 minutes. This contrasts with his profound disturbance in both recall and recognition on other anterograde memory tests (word lists, stories, figures, environmental sounds, sounds of musical instruments), and marked impairment on measures of remote memory (famous faces, autobiographical memory). SL showed milder deficits in confrontation naming, verbal fluency and attention, but no dyspraxia or aphasic comprehension deficits. Except for the Block Design test, his visuospatial skills were intact. SL's learning of the new song in the absence of any evidence of episodic memory is reminiscent of patients with temporal lobe amnesia who show better memory for song melody than for lyrics or verse, although his retention was not as good.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16210231 &1355-4794 Case Reports Journal Article16210231Department of Psychiatry, Center for Alzhemer's and Neurodegenerative Disorders, Veterans Affairs Medical Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73190, USA.~?, Engen, R. L.2005IThe singer's breath: implications for treatment of persons with emphysema20-48 J Music Ther421Aged Aged, 80 and over Analysis of Variance *Breathing Exercises Female Humans Male Music Therapy/*methods Pulmonary Emphysema/prevention & control/*therapy *Quality of Life Questionnaires Southeastern United States Time Factors Treatment Outcome Vocal Cords *Voice TrainingSpringThis study investigated the effects of group singing instruction on the physical health and general wellness of senior citizens with emphysema. Subjects (n = 7) participated in 6 weeks of group vocal instruction, which emphasized breath management techniques. Dependent measures reflected physical health, functional outcomes, and quality of life. No significant differences were found on measures of physical health (FEV1, inspiratory threshold, distance walked, and The DUKE physical health subscale). Measures of functional outcomes each showed a significant change across time. Results of the ANOVAs for breath management (extent of counting) and breath support (intensity of speech) were significant (p < .038 & p < .000 respectively). Descriptive analyses showed a clear and dramatic shift in breathing mode from clavicular to diaphragmatic breathing that was maintained 2 weeks after the treatment period. Quality of life measures (subjective scales and The Duke Health Profile) yielded mixed results. Findings of this study suggest that vocal instruction, inclusive of breathing exercises, may help to improve the quality of life for senior citizens with emphysema. Subjects in this study responded positively to the instruction and further investigation of the treatment method is warranted.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15839731 (0022-2917 Clinical Trial Journal Article15839731Queens University of Charlotte. ?-4 Crnivec, R.2004bAssessment of health risks in musicians of the Slovene Philharmonic Orchestra, Ljubljana, Slovenia140-5&Medical Problems of Performing Artists193.This study consisted of medical examination and comparison of results obtained in 70 musicians from the Slovene Phil-harmonic Orchestra, Ljubljana. The main goals of the study were to identify performance-related musculoskeletal disorders, to assess the health status and working capacity of the musicians, and to propose measures for improved protection of their health. The results were compared with results obtained in a control group of 28 marketing workers at Philip Morris Enterprise, Ljubljana. Musculoskeletal problems of the studied group of Slovene musicians were compared with problems of 109 musicians of the Berlin Opera Orchestra examined at the Institute of Occupational Health, Berlin, Germany. We identified performance-related diseases (inflammatory and degenerative skeletal disorders and minor occupational hearing impairments) that were most frequent. A significant proportion of performing musicians had overuse syndrome, caused by excessive use of the extremities and characterized by cumulative microtrauma exceeding human physiologic limits, and dermatologic problems, such as finger calluses and "fiddler's neck." The most frequent musculoskeletal problems were due to repetitive motion, unphysiologic postures (isometric strain on the affected muscles), and prolonged sitting position during performances. The highest level of musculoskeletal disorders was noted in the double bass and cello sections, followed by violin, viola, woodwind, and brass players. The severity of physical impairments and restricted ability to perform music were correlated with age, duration of classical music performance, and total length of service. In the group of Slovenian musicians, the incidence of health problems in general was twice as high as in the control group, whereas the incidence of musculoskeletal disorders was six times as high as that in the control group. Health status of the musicians in terms of moderate and severe physical impairments was worse than in the control group. Measures for improved health protection and better performance ability were proposed. University Medical Centre Ljubljana Institute of Occupational, Traffic and Sports Medicine, Poljanski nasip 58, 1000 Ljubljana, Slovenia; institut.kimdps@guest.arnes.si.?.f Britsch, L.2005=Investigating performance-related problems of young musicians40-7&Medical Problems of Performing Artists201TMany investigators have expressed concern about the paucity of research literature on the subject of younger musicians, particularly adolescents, and little is known about their performance-related injuries. This study was undertaken to explore this neglected area. Ninety-seven students in four youth orchestras in a midsized midwestern city were surveyed to examine the relationships between such factors as practice time and pain, to explore what students do when they experience pain while playing, and to determine whether students have been exposed to any injury prevention education. Few reported accepting the belief of playing through pain, while performance anxiety was reported at a higher-than-expected rate. The older students had more awareness of possible causes of playing-related pain and strategies for its elimination than did the younger students. The older students also discussed their pain with teachers more frequently than did the younger students. It appeared that those students who sought help from teachers for their performance-related problems received information that was beneficial in reducing or solving the problem. Two statistically significant relationships were found; one between amount of practice time and grade of pain reported in the youngest orchestra, and the other comparing females by age and grade of pain reported.HMichigan State University, East Lansing, Michigan; lbritsch@hotmail.com.?/Brodsky, M. Hui, K.2004^An innovative patient-centered approach to common playing-related pain conditions in musicians170-3'Medical Problems of Performing Artists.194dMusicians are increasingly seeking out complementary and alternative medicine (CAM) to relieve suffering that results from playing-related pain conditions. Using an innovative patient-centered model, an approach has been developed that can incorporate various medical systems and therapeutics to offer safe, effective, affordable, and accessible health care for musicians. A case discussion explores how musicians, through combining different traditions of medicine in orchestration, can optimize their quality of life while meeting their needs of prevention and rehabilitation of occupation- related conditions.UCLA Center for East-West Medicine, Dept of Medicine, David Geffen School of Medicine at UCLA, 2428 Santa Monica Blvd, Suite 308, Santa Monica, CA 90404; MEBrodsky@mednet.ucla.edu.~?0Baptista, L. F. Keister, R. A.2005$Why birdsong is sometimes like music426-43Perspect Biol Med483ZAnimals Comparative Study Europe Humans *Music *Songbirds/physiology *Vocalization, AnimalSummerThe sounds and songs of birds have inspired the musical compositions of numerous cultures throughout the globe. This article examines a variety of compositions from Western music that feature birdsong and explores the concept of birds as both vocalists and instrumentalists. The concept of birds as composers is then developed-how they use rhythmic variations, pitch relationships, and combinations of notes similar to those found in music-and the theory that birds create variation in their songs partially to avoid monotony is considered. Various families of birds that borrow sounds from other species are surveyed, in particular the European starling (Sturnus vulgaris), which may have inspired a Mozart composition. We conclude that the fusion of avian bioacoustics and the study of birdsong in music may function as a conservation tool, raising the awareness of humans and stimulating future generations to save for posterity what remains of the natural world.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16085998 0031-5982 Journal Article16085998?Department of Ornithology, California Academy of Sciences, USA. c~?1 Byl, N. N.2003<What can we learn from animal models of focal hand dystonia?857-73Rev Neurol (Paris)15910 Pt 1OAnimals Aotinae Brain Mapping Conditioning, Operant/physiology Cytokines/metabolism Disease Models, Animal Dystonic Disorders/*physiopathology Electrophysiology Female Hand/*physiopathology/surgery Hand Strength/physiology Movement/physiology Psychomotor Performance/physiology Rats Rats, Sprague-Dawley Somatosensory Cortex/physiologyOct3Focal hand dystonia (FHd) is a disabling disorder of hand control characterized by a loss of inhibition and involuntary co-contractions of agonists and antagonists that can develop in motivated, productive individuals performing highly repetitive, intensive hand tasks. It is our hypothesis that FHd can result from aberrant learning. We summarize three behavioral animal models (Nancymae aotus owl monkeys and Sprague Dawley rats) that provide evidence supporting aberrant learning as one origin of FHd. Hand task behaviors that increase the risk for repetitive strain injury-FHd include: attended, precise, repetitive behaviors that involve near coincident inputs-outputs (e.g. rapid reversal of agonists-antagonists, stereotypical movements, stressful end range motions, cutaneous stimulation across broad surfaces). High force, vibration, congenital abnormalities, and stress can further increase the risk. The central consequences of aberrant learning include large sensory receptive fields (rfs), significant overlap of rfs across adjacent digits and across glabrous and dorsal surfaces, and the persistence of digital representations across a broad cortical distance (>600 microm). Behavioral animal models are valid for the study of FHd etiology and could logically be applied to study the effects of pharmaceutical, surgical, anatomical, and behavioral enrichment intervention strategies, but these models may have limitations in the study of the recovery of fine motor, articulated, interdigitated movements following progressive, learning based, complex sensorimotor training.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14615674 0035-3787 Journal Article14615674Department of Physical Therapy and Rehabilitation Science, School of Medicine, 1360 9th Ave. Box 0736, University of California, San Francisco, CA 942143-0736, USA. byl@itsa.ucsf.eduu~?2-Baader, A. P. Kazennikov, O. Wiesendanger, M.20056Coordination of bowing and fingering in violin playing436-43Brain Res Cogn Brain Res232-3Adult Biomechanics Fingers/*physiology Humans Laterality/physiology Motor Activity/*physiology *Music Occupations *Psychomotor PerformanceMaygPlaying string instruments implies motor skills including asymmetrical interlimb coordination. How special is musical skill as compared to other bimanually coordinated, non-musical skillful performances? We succeeded for the first time to measure quantitatively bimanual coordination in violinists playing repeatedly a simple tone sequence. A motion analysis system was used to record finger and bow trajectories for assessing the temporal structure of finger-press, finger-lift (left hand), and bow stroke reversals (right arm). The main results were: (1) fingering consisted of serial and parallel (anticipatory) mechanisms; (2) synchronization between finger and bow actions varied from -12 ms to 60 ms, but these 'errors' were not perceived. The results suggest that (1) bow-finger synchronization varied by about 50 ms from perfect simultaneity, but without impairing auditory perception; (2) the temporal structure depends on a number of combinatorial mechanisms of bowing and fingering. These basic mechanisms were observed in all players, including all amateurs. The successful biomechanical measures of fingering and bowing open a vast practical field of assessing motor skills. Thus, objective assessment of larger groups of string players with varying musical proficiency, or of professional string players developing movement disorders, may be helpful in music education.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15820650 0926-6410 Journal Article15820650;Department of Physiology, University of Berne, Switzerland.~?3Bangert, M. Altenmuller, E. O.2003KMapping perception to action in piano practice: a longitudinal DC-EEG study26 BMC Neurosci41Adult Attention/physiology Auditory Pathways/physiology Auditory Perception/*physiology Brain/physiology Brain Mapping/*methods Electroencephalography/instrumentation/*methods Evoked Potentials/*physiology Eye Movements/physiology Female Hand/physiology Humans Longitudinal Studies Male Motor Activity/*physiology Motor Skills/physiology *Music Neuronal Plasticity/physiology Pitch Perception/physiology Research Support, Non-U.S. Gov'tOct 15DBACKGROUND: Performing music requires fast auditory and motor processing. Regarding professional musicians, recent brain imaging studies have demonstrated that auditory stimulation produces a co-activation of motor areas, whereas silent tapping of musical phrases evokes a co-activation in auditory regions. Whether this is obtained via a specific cerebral relay station is unclear. Furthermore, the time course of plasticity has not yet been addressed. RESULTS: Changes in cortical activation patterns (DC-EEG potentials) induced by short (20 minute) and long term (5 week) piano learning were investigated during auditory and motoric tasks. Two beginner groups were trained. The 'map' group was allowed to learn the standard piano key-to-pitch map. For the 'no-map' group, random assignment of keys to tones prevented such a map. Auditory-sensorimotor EEG co-activity occurred within only 20 minutes. The effect was enhanced after 5-week training, contributing elements of both perception and action to the mental representation of the instrument. The 'map' group demonstrated significant additional activity of right anterior regions. CONCLUSION: We conclude that musical training triggers instant plasticity in the cortex, and that right-hemispheric anterior areas provide an audio-motor interface for the mental representation of the keyboard.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14575529 1471-2202 Journal Article14575529Institute of Music Physiology and Musicians Medicine, Hanover University of Music and Drama, Hohenzollernstrasse 47, D-30161 Hanover, Germany. mbangert@bidmc.harvard.edu~?4#Bella, S. D. Peretz, I. Aronoff, N.2003:Time course of melody recognition: a gating paradigm study1019-28Percept Psychophys657Acoustic Stimulation Adult *Attention *Auditory Perception Female Humans Male *Mental Recall *Music Practice (Psychology) Psychoacoustics *Reaction Time Research Support, Non-U.S. Gov't Set (Psychology)OctERecognizing a well-known melody (e.g., one's national anthem) is not an all-or-none process. Instead, recognition develops progressively while the melody unfolds over time. To examine which factors govern the time course of this recognition process, the gating paradigm, initially designed to study auditory word recognition, was adapted to music. Musicians and nonmusicians were presented with segments of increasing duration of familiar and unfamiliar melodies (i.e., the first note, then the first two notes, then the first three notes, and so forth). Recognition was assessed after each segment either by requiring participants to provide a familiarity judgment (Experiment 1) or by asking them to sing the melody that they thought had been presented (Experiment 2). In general, the more familiar the melody, the fewer the notes required for recognition. Musicians judged music's familiarity within fewer notes than did nonmusicians, whereas the reverse situation (i.e., musicians were slower than nonmusicians) occurred when a sung response was requested. However, both musicians and nonmusicians appeared to segment melodies into the same perceptual units (i.e., motives) in order to access the correct representation in memory. These results are interpreted in light of the cohort model (Marslen-Wilson, 1987), as applied to the music domain.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14674630 0031-5117 Journal Article14674630GUniversity of Montreal, Montreal, Quebec, Canada. dalla-bella.2@osu.edu (?5HKde Greef, M. van Wijck, R. Reynders, K. Toussaint, J. Hesseling, R.2003Impact of the Groningen Exercise Therapy for Symphony Orchestra Musicians program on perceived physical competence and playing-related musculoskeletal disorders of professional musicians156-60&Medical Problems of Performing Artists184The goal of the Groningen Exercise Therapy for Symphony Orchestra Musicians (GETSOM) program is to change the limited repetitive motion and playing habits of musicians and stimulate their motion repertoire to reduce the effects of physical overload. The research was motivated directly by the high rate of absences due to illness in a regional symphony orchestra resulting from playing-related musculoskeletal disorders (PRMDs). The secondary preventive effects of the GETSOM program on perceived physical competence and PRMDs were studied in a clinical trial in which 45 professional musicians of a symphony orchestra were included and randomized to an experimental (n = 17) and a control group (n = 28). To decrease PRMDs, the GETSOM program focuses on enhancing the perceived physical competence of musicians. The program pays special attention to relaxation, postural exercises for the shoulder, neck, and lower back; and exercises to enhance physical workload and deal with mental stress. Participation in the 15week GETSOM program has shown a statistically significant (p < 0.05) and clinically relevant (d > 0.20) increase in perceived physical competence and a decrease in PRMDs in the experimental group compared with the control group. According to a multiple regression analysis, 45% of the decrease in PRMDs was explained by an increase in physical competence. There is evidence that the GETSOM program is efficacious in promoting changes in perceived physical competence and a decrease in PRMDs.Associate Professors, Institute of Human Movement Sciences, University of Groningen, PO Box 196, 9700 AD Groningen, The Netherlands; m.de.greef@ppsw.rug.nlb~?6 Brandfonbrener, A. G. Robson, C.2004iReview of 113 musicians with focal dystonia seen between 1985 and 2002 at a clinic for performing artists255-6 Adv Neurol94Dystonic Disorders/*physiopathology/*therapy Humans Movement Disorders/etiology Muscle Fatigue *Music Occupational Diseases/*physiopathology/*therapyfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14509681 10091-3952 Journal Article Review Review, Tutorial14509681dMedical Program for Performing Artists, Rehabilitation Institute of Chicago, Chicago, Illinois, USA.~?7(Hagberg, M. Thiringer, G. Brandstrom, L.2005Incidence of tinnitus, impaired hearing and musculoskeletal disorders among students enrolled in academic music education--a retrospective cohort study575-83Int Arch Occup Environ Health787AugThe aim was to determine the incidence of tinnitus, impaired hearing and musculoskeletal disorders among musicians and the relation to the number of practicing hours and/or the instrument type before the onset of symptoms. METHOD: The study base consisted of students enrolled in the School of Music and Music Education at Goteborg University between the years 1980 and 1995. There were 407 of the 602 original students that answered a questionnaire (response rate of 68%). The questionnaire concerned exposure before and after the enrollment in the Music Academy, as well as onset of symptoms. RESULTS: The highest incidence of symptoms was found for reported tinnitus with a rate of 10.6 per 1000 years of instrumental practice. There was a relationship between exposure to the number of hours of instrumental practice and incidence of impaired hearing. Among the musculoskeletal symptoms the highest incidences per 1000 years of instrumental practice were pain in the neck and in the left shoulder with a rate of 4.4 and 4.6 disorders per 1000 years of instrumental practice, respectively. There was 2.4 times higher incidence for musculoskeletal disorders in the right hand/wrist and a 2.2 times higher incidence in the left elbow/forearm for musicians who practiced for 20 h or more per week before the onset of disorders compared to those who practiced fewer than 20 h per week when controlling for age and gender. Musicians with a violin or a viola as the main instrument had four times the incidence for right elbow/forearm disorder and twice the incidence of neck pain, pain in the right shoulder and the left elbow/forearm compared to those who had piano as the main instrument.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16028091 0340-0131 Journal Article16028091Department of Occupational Medicine, Sahlgrenska Academy at Goteborg University, 41266 Goteborg, Sweden. mats.hagberg@ymk.gu.se~?8 Amadio, P. C.20035Management of nerve compression syndrome in musicians279-86, vi-vii Hand Clin192cHumans *Music Nerve Compression Syndromes/etiology/*therapy Occupational Diseases/etiology/*therapyMayNerve compression syndromes are common in the general population, and they are also common in musicians. As many as 30% of musicians who have a recognized musculoskeletal disorder are diagnosed with a nerve compression syndrome. Thus, it is important to consider the diagnosis of nerve compression syndromes in all musicians who present with musculoskeletal complaints. Proper management of these problems is essential if one is to avoid significant morbidity.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12852670 10749-0712 Journal Article Review Review, Tutorial12852670Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA. pamadio@mayo.edu ?9 Dawson, W.J.2005.Intrinsic muscle strain in the instrumentalist66-9&Medical Problems of Performing Artists202Adolescence Adult Aged Child Comparative Studies Descriptive Statistics Female Forearm Injuries *Hand Injuries/ep [Epidemiology] *Hand Injuries/th [Therapy] Illinois Injury Pattern/ev [Evaluation] Male Middle Age *Music *Occupational-Related Injuries/ep [Epidemiology] *Occupational-Related Injuries/th [Therapy] *Performing Artists Physical Performance/ev [Evaluation] Prospective Studies Record Review Retrospective Design Sprains and Strains/et [Etiology] Sprains and Strains/rf [Risk Factors] *Sprains and Strains/ep [Epidemiology] *Sprains and Strains/th [Therapy] Upper Extremity/in [Injuries]The playing of many musical instruments is performed principally by the small intrinsic muscles of the hands. Practice records were reviewed to investigate the epidemiology, etiology, and risk factors for intrinsic muscle strain. Fifty-one instrumentalists were found, out of 129 having strains of all hand and forearm muscles. These 51 comprised 15.5% of all 329 musicians seen for overuse-related conditions. The patients[inverted question mark] ages ranged from 10 to 72 years; 20 were male. Forty-one of the 51 played keyboard or stringed instruments; 11 of the 19 stringed instruments were bowed. Twentyone patients were professionals or university conservatory music students. Sixty percent of strains were caused by playing music, with slightly more than half being in the professional/collegiate cohort. Pianists were more likely to experience right hand involvement. Seven patients had bilateral intrinsic strains. Thirteen experienced concomitant strains of the extrinsic forearm muscles, either on the same side or bilaterally with bilateral intrinsic strains. Treatment followed standard principles, with hand rest prescribed in 12, musical practice changes in 19, activity modification in 30, and formal exercises/hand therapy in 23. Nonsteroidal medication was prescribed in 17 cases. The data suggest that intrinsic muscle strains related to overuse follow the same etiologic and anatomic patterns as other upper extremity muscle strain and pain syndromes and have the same risk factors. Health care providers should be aware of the role of the hand intrinsic muscles in playing musical instruments and their propensity for overuse-related strain syndromes from both musical and nonmusical activities.~?:GBengtsson, S. L. Nagy, Z. Skare, S. Forsman, L. Forssberg, H. Ullen, F.2005VExtensive piano practicing has regionally specific effects on white matter development1148-50 Nat Neurosci89SepUsing diffusion tensor imaging, we investigated effects of piano practicing in childhood, adolescence and adulthood on white matter, and found positive correlations between practicing and fiber tract organization in different regions for each age period. For childhood, practicing correlations were extensive and included the pyramidal tract, which was more structured in pianists than in non-musicians. Long-term training within critical developmental periods may thus induce regionally specific plasticity in myelinating tracts.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16116456 1097-6256 Journal Article16116456ZDepartment of Woman and Child Health, Karolinska Institutet, SE-171 77, Stockholm, Sweden.&~?;Jabusch, H. C. Altenmuller, E.2004gThree-dimensional movement analysis as a promising tool for treatment evaluation of musicians' dystonia239-45 Adv Neurol94dAdult Botulinum Toxins/therapeutic use Dystonia/drug therapy/physiopathology/*rehabilitation *Evaluation Studies Female Fingers/physiology Follow-Up Studies Hand Strength Humans Movement Disorders/etiology *Music Occupational Diseases/drug therapy/physiopathology/*rehabilitation *Physical Therapy Techniques Task Performance and Analysis Treatment Outcomefhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14509679 &0091-3952 Case Reports Journal Article14509679gInstitute of Music Physiology and Musicians' Medicine, University of Music and Drama, Hanover, Germany.~?<SMeister, I. G. Krings, T. Foltys, H. Boroojerdi, B. Muller, M. Topper, R. Thron, A.2004UPlaying piano in the mind--an fMRI study on music imagery and performance in pianists219-28Brain Res Cogn Brain Res193Adult Brain/*physiology Comparative Study Female Humans Imagination/*physiology Magnetic Resonance Imaging/*methods Male *Music Nerve Net/physiology Psychomotor Performance/*physiology Research Support, Non-U.S. Gov'tMayReading of musical notes and playing piano is a very complex motor task which requires years of practice. In addition to motor skills, rapid and effective visuomotor transformation as well as processing of the different components of music like pitch, rhythm and musical texture are involved. The aim of the present study was the investigation of the cortical network which mediates music performance compared to music imagery in 12 music academy students playing the right hand part of a Bartok piece using functional magnetic resonance imaging (fMRI). In both conditions, fMRI activations of a bilateral frontoparietal network comprising the premotor areas, the precuneus and the medial part of Brodmann Area 40 were found. During music performance but not during imagery the contralateral primary motor cortex and posterior parietal cortex (PPC) bilaterally was active. This reflects the role of primary motor cortex for motor execution but not imagery and the higher visuomotor integration requirements during music performance compared to simulation. The notion that the same areas are involved in visuomotor transformation/motor planning and music processing emphasizes the multimodal properties of cortical areas involved in music and motor imagery in musicians.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15062860 0926-6410 Journal Article15062860qDepartment of Neurology, University Hospital Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany. igmeister@gmx.de =~?=<Tervaniemi, M. Just, V. Koelsch, S. Widmann, A. Schroger, E.2005kPitch discrimination accuracy in musicians vs nonmusicians: an event-related potential and behavioral study1-10 Exp Brain Res1611Acoustic Stimulation/*methods Adult Comparative Study Evoked Potentials, Auditory/*physiology Female Humans Male *Music Pitch Discrimination/*physiology Reaction Time/*physiology Research Support, Non-U.S. Gov'tFeb<Previously, professional violin players were found to automatically discriminate tiny pitch changes, not discriminable by nonmusicians. The present study addressed the pitch processing accuracy in musicians with expertise in playing a wide selection of instruments (e.g., piano; wind and string instruments). Of specific interest was whether also musicians with such divergent backgrounds have facilitated accuracy in automatic and/or attentive levels of auditory processing. Thirteen professional musicians and 13 nonmusicians were presented with frequent standard sounds and rare deviant sounds (0.8, 2, or 4% higher in frequency). Auditory event-related potentials evoked by these sounds were recorded while first the subjects read a self-chosen book and second they indicated behaviorally the detection of sounds with deviant frequency. Musicians detected the pitch changes faster and more accurately than nonmusicians. The N2b and P3 responses recorded during attentive listening had larger amplitude in musicians than in nonmusicians. Interestingly, the superiority in pitch discrimination accuracy in musicians over nonmusicians was observed not only with the 0.8% but also with the 2% frequency changes. Moreover, also nonmusicians detected quite reliably the smallest pitch changes of 0.8%. However, the mismatch negativity (MMN) and P3a recorded during a reading condition did not differentiate musicians and nonmusicians. These results suggest that musical expertise may exert its effects merely at attentive levels of processing and not necessarily already at the preattentive levels.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15551089 0014-4819 Journal Article15551089Cognitive Brain Research Unit, Department of Psychology, University of Helsinki, Helsinki Brain Research Centre, PO Box 9, 00014 Helsinki, Finland. mari.tervaniemi@helsinki.fi~?>7Boga, C. Ozdogu, H. Tamer, L. Kizilkilic, E. Tuncer, I.2005GAplastic anemia in a professional musician exposed to instrument polish304-6 Int J Hematol814Adult Anemia, Aplastic/*chemically induced Arylamine N-Acetyltransferase/genetics Glutathione Transferase/genetics Humans Industrial Oils/*adverse effects Male Music *Occupational Exposure Polymorphism, GeneticMayChemicals are known to cause toxin-induced aplastic anemia. However, some chemicals documented in only a few cases to possess only a possibility of toxic potential may also be responsible for the development of aplastic anemia. This report presents a case of a string musician with bone marrow failure. The patient used a certain type of polish (komalak) to shine his musical instrument and did this frequently. He presented with nasal bleeding, and a workup on admission revealed pancytopenia. Aplastic anemia was diagnosed on the basis of bone marrow histology results. An analysis for gene polymorphism related to the metabolic detoxification enzymes glutathione S-transferase and N-acetyltransferase 2 indicated that the patient was genetically susceptible to developing toxicity. This case suggests that frequent use of this polish may cause a toxic effect that leads to bone marrow failure. Musicians should be made aware of the risks associated with these types of chemicals.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15914359 &0925-5710 Case Reports Journal Article15914359Division of Hematology, Department of Internal Medicine, Baskent University Faculty of Medicine, Adana Teaching and Medical Research Center, Adana, Turkey. drcanboga@hotmail.com )??Ackermann, B.J. Adams, R.2005NFinger movement discrimination in focal hand dystonia: case study of a cellist77-81&Medical Problems of Performing Artists202Clinical Assessment Tools Data Analysis Software Descriptive Statistics *Dystonia/rh [Rehabilitation] *Fingers/ph [Physiology] Functional Assessment *Hand/pa [Pathology] Male Middle Age *Music *Occupational Diseases/rh [Rehabilitation] *Performing Artists Physical Examination Pilot Studies Pretest-Posttest Design *Proprioception Psychomotor Performance/ed [Education] *Psychophysiology ROC Curve Sensation/ev [Evaluation] Simulations Splints Therapeutic Exercise Instrumentation Candia dystonia evaluation scale. Tubiana and Chamagne evaluation scale.Focal hand dystonia in musicians has received increasing attention in recent years due to the debilitating and careerthreateningmnature of this condition. In cellists, focal hand dystonia is reported only infrequently in the existing literature, as compared to the rate in other instrumentalists, such as pianists and violinists. Although relatively less common, it has similarly devastating effects for those with this disorder. In the pilot study presented here, a 47-year-old male professional cellist experiencing left focal hand dystonia underwent pretests and posttests when he attended a 10-day period of intensive sensorimotor retraining. To monitor the effects of treatment, a pseudo-cello was designed that used the principles of psychophysical methodology to test active finger movement discrimination. This test was designed to evaluate whether this cellist could perceive the relative position of his left fingers in as task-specific a manner as possible. The pseudo-cello results showed a reduced ability to discriminate the height and tension of a string in the fingers most affected by the dystonia. Following the 10-day period of intensive physiotherapy, discrimination of finger movements had improved in the fingers that had been worked on with the rehabilitation program, and this corresponded with an improvement in the dystonia rating scale. The positive results obtained here suggest that this form of testing in focal hand dystonia warrants further research.,~?@ Boyette, J.2005/Splinting for adaptation of musical instruments99-106Work252Classic instrument design does not always match the physical capacity of the musician, as instruments are often chosen because of the pleasing sound and not the ease of play. Devices that are commercially available to create a more ergonomic structure may not address the specific needs of a musician with a chronic condition. Through basic splinting of the musician with an injury, these physical stressors can be reduced, allowing the continuation of musical practice and performance. Appropriate design modification requires a solid understanding of upper extremity anatomy, splint design technique, and the biomechanic principles of playing the instrument. Through knowledge of music theory and appreciation, one may modify the instrument while protecting tonal flexibility, resonance, mechanical freedom, and sound quality. Two case studies present a range of splint design, from small to large, static to dynamic, and for congenital or chronic conditions.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16131739 1051-9815 Journal Article16131739jHealthSouth Shepherd Plaza, 2158 Portsmouth Road, Houston, TX 77098, USA. Jennifer.Boyette@healthsouth.com?Ah$Lee, S. Hanks, K.B. Schwartz, J.2005%Pianist's rehabilitation: three cases35-9&Medical Problems of Performing Artists201kThree pianists, each with academic and performing credentials, shared their experiences of physical problems, treatment, and rehabilitation. Preparing for solo performance puts an inordinate demand on mental and physical functioning and family life for the pianist in academia. Pianists, who must demonstrate technical and artistic prowess while teaching heavy loads, can easily overuse their piano-playing mechanisms by playing difficult works without proper conditioning and necessary rest. This can result in gradual or sudden bodily pain and incapacitation. Minor pains and injuries of the pianists profiled here were overcome by applying proper piano techniques. More serious injuries needed medical attention, alternative therapies, and combined management programs. With good health care and proper technical approach all three pianists resumed active performing life.School of Music, College of Visual and Performing Arts, University of South Florida, 4202 East Fowler Ave, FH 110, Tampa, FL 33620-7350; slee7@arts.usf.edu.~?BBarr, A. E. Barbe, M. F.2004pInflammation reduces physiological tissue tolerance in the development of work-related musculoskeletal disorders77-85J Electromyogr Kinesiol141Animals Human Inflammation/*physiopathology Models, Theoretical Musculoskeletal Diseases/*etiology/physiopathology Occupational Diseases/*etiology/physiopathology Support, Non-U.S. Gov't Support, U.S. Gov't, P.H.S.FebWork-related musculoskeletal disorders (MSDs) cause substantial worker discomfort, disability and loss of productivity. Due to the difficulty in analyzing the tissues of patients in the early stages of work-related MSD, there is controversy concerning the pathomechanisms of the development of these disorders. The pathophysiology of work-related MSD can be studied more easily in animal models. The purpose of this review is to relate theories of the development of tissue injury due to repeated motion to findings of recent investigations in animals that address the role of the inflammatory response in propagating tissue injury and contributing to chronic or recurring tissue injury. These tissue effects are related to behavioral indicators of discomfort and movement dysfunction with the aim of clarifying key time points for specific intervention approaches. The results from animal models of MSD are discussed in the light of findings in patients, whose tissues are examined at a much later phase of MSD development. Finally, a conceptual model of the potentially negative impact of inflammation on tissue tolerance is proposed along with suggestions for future research directions.ehttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=1475975321050-6411 Journal Article Review Review Literature14759753Physical Therapy Department, College of Health Professions, Temple University, 3307, North Broad Street, Philadelphia, PA 19147, USA. aebarr@temple.edu7~?CVerheul, M. H. Geuze, R. H.2004gBimanual coordination and musical experience: the role of intrinsic dynamics and behavioral information270-91 Motor Control83Adult Female Hand/*physiology Humans Male Memory Models, Statistical Motor Skills/*physiology *Music *Periodicity Psychomotor Performance/*physiology Research Support, Non-U.S. Gov'tJulRhythmic interlimb coordination arises from the interaction of intrinsic dynamics and behavioral information, that is, intention, memory, or external information specifying the required coordination pattern. This study investigates the influence of the content of memorized behavioral information on coordination in musically experienced and inexperienced participants. These groups are hypothesized to have different intrinsic dynamics for this task. Stability was assessed in a switching task (variability and switching time). The in-phase, anti-phase, and 90 degrees -phase difference were specified in a neutral and an ecologically relevant manner. Musicians showed more stable coordination than nonmusicians did. No interaction effect was found with memorized behavioral information. Behavioral information showed an interaction effect with phase pattern on coordination variability, with the strongest effect for the 90 degrees -phase pattern. Switching time was affected largely in line with the findings for coordination variability. Participants showed an intraindividual preference for one type of gallop and one type of switch strategy, suggesting different hand roles for the two hands.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15322308 1087-1640 Journal Article15322308yInstitute for Biophysical and Rersearch into Human Movement, Manchester Metropolitan University, Alsager, United Kingdom. q?DGVisentin, P. Shan, G.2003}The kinetic characteristics of the bow arm during violin performance: an examination of internal loads as a function of tempo91-7&Medical Problems of Performing Artists183Studies show that 43% to 66% of professional musicians need to stop performing for extended periods due to occupational injuries, often identified as overuse syndrome. Repetitive movement may be the mechanism of these injuries, but the identification of causal factors requires quantitative research into the kinematic and kinetic characteristics of musical performance. The current study examines internal loads of the bow arm during a legato (smooth) bowing technique at a variety of tempos (speeds). Eight professional-level violinists participated in the study. A nine-camera VICON v8i system was used to capture and synchronize upper body kinematics with sound and video. Using a 10-segment biomechanical model (head, trunk, upper arms, lower arms, hands, bow, and violin) and applying inverse dynamic analysis to the kinematic data, moments and forces loading the joints (shoulder, elbow, and wrist) were calculated, revealing quantitative characteristics of the joint load. The results show that load can be measured in terms of quantity and quality, with quantity influenced by factors such as the string played and tempo and quality defined in terms of the type of load (static, quasi-static, dynamic, fundamental, and impact) and psychological and physical constraints. Inverse dynamic analysis reveals that: 1) right shoulder loads vary in quantity and quality depending on the string played, whereas wrist and elbow loads are independent of the string played; 2) loading may be divided into three discrete phases-increasing physical effort, optimization, and approaching physiologic limits; and 3) several factors contribute to impact loading, and tempo plays a dominant role. This is the first study providing quantitative three-dimensional kinematic and kinetic information on the bow and on the bow arm, laying the foundation for further exploration of the causal factors of overuse syndrome and for the potential development of practices that might minimize t! hese injuries.tDept of Music, University of Lethbridge, 4401 University Dr, Lethbridge, Alberta, T1K 3M4, Canada; visentin@uleth.caE?EHVisentin, P. Shan, G.2004An innovative approach to understand overuse injuries: biomechanical modeling as a platform to intergrate information obtained from various analytic tools90-6&Medical Problems of Performing Artists192{ A cognitive shift is evident among the medical practitioners, performers, educators, and researchers who deal with over-use syndrome (OS) injuries. These groups now are clearly concerned with prevention as a desired strategy. Realistically the medical community must take on the burden of changing attitudes within the artistic community. Because artistic success or failure often is deter-mined by microincrements of "ability," performers and educators (individuals in the greatest position of influence over aspiring students) have been slow to change, and thoughtful training often takes a back seat to immediacy of skill acquisition. In our opinion, professionals will adopt alternate practices only if the weight of scientific evidence proves sufficient to challenge centuries of tradition. A clear message to the artistic community requires (1) clarity of definition, (2) convincing methodology, (3) consistent means of situational comparison, and (4) solutions that do not compromise the artist's perceptions of the end product. Current definitions of OS typically fail to differentiate between physiologic tolerance (a time-based concept) and physiologic limits (momentary impact conditions). The medical community must get the message across that physiologic tolerance is entirely different from physiologic limits. Although diverse methods are used to evaluate OS injuries, individually none can quantify directly physiologic tolerance. This difficulty justifies the use of indirect means to (1) describe accurately the movements that are thought to cause the injury, (2) link external description with internal physiologic conditions, and (3) determine relationships that allow one to quantify levels of injury risk. In this context, biomechanical modeling has the potential to serve as a nexus for evaluating information obtained from multiple methodologies. This article validates the use of biomechanical modeling as a platform of information integration in the evaluation of OS. An examination of modeling theory in terms of typic al OS conditions reveals a new mathematical representation, one that may serve to focus future discussions of efficiency related to prevention and effectiveness related to learning. accurately the movements that are thought to cause the injury, (2) link external description with internal physiologic conditions, and (3) determine relationships that allow one to quantify levels of injury risk. In this context, biomechanical modeling has the potential to serve as a nexus for evaluating information obtained from multiple methodologies. This article validates the use of biomechanical modeling as a platform of information integration in the evaluation of OS. An examination of modeling theory in terms of typical OS conditions reveals a new mathematical representation, one that may serve to focus future discussions of efficiency related to prevention and effectiveness related to learning.wDepartment of Music, University of Lethbridge, 4401 University Drive, Lethbridge, AB, Canada T1K 3M4; visentin@cleth.ca~?F1Ruano-Ravina, A. Figueiras, A. Barros-Dios, J. M.2003TMusicians playing wind instruments and risk of lung cancer: is there an association?143Occup Environ Med602Aged Case-Control Studies Humans Lung Neoplasms/*epidemiology Middle Aged *Music Occupational Diseases/*epidemiology Prevalence Risk Factors Spain/epidemiologyFebfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12554845 1351-0711 Letter12554845K?GHRobinson, B.S.2003cRehabilitation of a cellist after surgery for de Quervain's tenosynovitis and intersection syndrome106-12&Medical Problems of Performing Artists183This article describes the physical therapy intervention for a musician after surgery for de Quervain's tenosynovitis and intersection syndrome, and briefly reviews these two tendon conditions. The patient, an 18-year-old female cellist, initially presented with symptoms of de Quervain's tenosynovitis, including marked fibrosis of the first dorsal compartment, to the extent that surgical intervention was required. Seven months after decompression of the first dorsal tunnel, the second dorsal compartment was surgically released secondary to intersection syndrome. Physical therapy included the use of therapeutic exercise, joint mobilization, scar mobilization, soft tissue massage, stretching, and physical agents. Patient education regarding activity modification, management of cello playing, and posture while playing the cello and using a computer keyboard was vital to successful rehabilitation. The musician was able to return to playing the cello at her previous level of performance, practicing and performing an average of 3 to 4 h/day. Conservative treatment intervention during the 10 months preceding the current treatment may have been unsuccessful due to the absence of activity modification.zSouthwest Missouri State University, Dept of Physical Therapy, 901 S National Ave, Springfield, MO 65804; bsr916f@smsu.edu ~?HEPantev, C. Ross, B. Fujioka, T. Trainor, L. J. Schulte, M. Schulz, M.2003.Music and learning-induced cortical plasticity438-50Ann N Y Acad Sci999Auditory Cortex/*physiology Humans Learning/*physiology Magnetoencephalography *Music Neuronal Plasticity/*physiology Research Support, Non-U.S. Gov'tNovAuditory stimuli are encoded by frequency-tuned neurons in the auditory cortex. There are a number of tonotopic maps, indicating that there are multiple representations, as in a mosaic. However, the cortical organization is not fixed due to the brain's capacity to adapt to current requirements of the environment. Several experiments on cerebral cortical organization in musicians demonstrate an astonishing plasticity. We used the MEG technique in a number of studies to investigate the changes that occur in the human auditory cortex when a skill is acquired, such as when learning to play a musical instrument. We found enlarged cortical representation of tones of the musical scale as compared to pure tones in skilled musicians. Enlargement was correlated with the age at which musicians began to practice. We also investigated cortical representations for notes of different timbre (violin and trumpet) and found that they are enhanced in violinists and trumpeters, preferentially for the timbre of the instrument on which the musician was trained. In recent studies we extended these findings in three ways. First, we show that we can use MEG to measure the effects of relatively short-term laboratory training involving learning to perceive virtual instead of spectral pitch and that the switch to perceiving virtual pitch is manifested in the gamma band frequency. Second, we show that there is cross-modal plasticity in that when the lips of trumpet players are stimulated (trumpet players assess their auditory performance by monitoring the position and pressure of their lips touching the mouthpiece of their instrument) at the same time as a trumpet tone, activation in the somatosensory cortex is increased more than it is during the sum of the separate lip and trumpet tone stimulation. Third, we show that musicians' automatic encoding and discrimination of pitch contour and interval information in melodies are specifically enhanced compared to those in nonmusicians in that musicians show larger functional mismatch negativity (MMNm) responses to occasional changes in melodic contour or interval, but that the two groups show similar MMNm responses to changes in the frequency of a pure tone.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14681168 0077-8923 Journal Article Review14681168yThe Rotman Research Institute, Baycrest Centre for Geriatric Care, Toronto, Ontario, Canada. pantev@rotman-baycrest.on.cax~?ISchulz, M. Ross, B. Pantev, C.2003`Evidence for training-induced crossmodal reorganization of cortical functions in trumpet players157-61 Neuroreport141Acoustic Stimulation Adult Auditory Cortex/*physiology Auditory Perception/*physiology *Brain Mapping Cues Dominance, Cerebral Feedback, Psychological/*physiology Female Fingers/physiology Humans Learning/*physiology Lip/physiology *Magnetoencephalography Male *Music Neuronal Plasticity/*physiology Physical Stimulation Psychomotor Performance Research Support, Non-U.S. Gov't Somatosensory Cortex/*physiology Touch/*physiologyJan 20The aim of this study was to compare multimodal information processing in the somatosensory and auditory cortices and related multimodal areas in musicians (trumpet players) and non-musicians. Magnetoencephalographic activity (MEG) was recorded in response to five stimulus conditions from 10 professional trumpet players and nine musically untrained control subjects. Somatosensory and auditory stimuli were presented alone or in combination. Our data suggest that musicians, in general, process multisensory stimuli differently to the control group. When stimulating the lip in professional trumpet players, a multimodal interaction (expressed as difference between the multimodal response and the sum of unimodal responses) in the corresponding somatosensory cortex showed a positive peak at 33 ms, which was not found in the control group. Conversely, the control group shows a significant interaction of opposite polarity around 60-80 ms. We suggest that training-induced reorganization in musicians leads to a qualitatively different way to process multisensory information. It favors an early stage of cortical processing, which is modified by the connections between multimodal and auditory neurons from thalamus to primary somatosensory area.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12544849 0959-4965 Journal Article12544849The Rotman Research Institute, Baycrest Centre for Geriatric Care, University of Toronto, 3560 Bathurst Street, Toronto, Ontario, Canada M6A 2E1.~?JStewart, L. Walsh, V.2005)Infant learning: music and the baby brainR882-4 Curr Biol1521Nov 80When it comes to listening to music, infants literally have a more open mind than their parents. Studies which investigate listening behaviour of babies and adults have shown that, as we learn to discriminate the musical sounds in our own environment, we become less sensitive to those of other cultures.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16271862 0960-9822 Journal Article16271862oUniversity of Newcastle and Wellcome Department of Imaging Neuroscience, University College London, London, UK.~?K Winspur, I.2003LControversies surrounding "misuse," "overuse," and "repetition" in musicians325-9, vii-viii Hand Clin192Cumulative Trauma Disorders/etiology/*physiopathology Hand/*physiopathology Humans Muscle Fatigue/physiology *Music Occupational Diseases/etiology/*physiopathologyMayDMedical opinion remains divided on the existence of a specific medical entity of nonspecific arm pain produced by repetition. Controversy also exists in the pathophysiology of certain painful, anatomically defined medical conditions in the hand and arm and the role of repetition, cumulative trauma, and microtrauma in the development of these conditions. The flaws in science and the language are examined in this article, as are the results of a survey of Australian music students in comparison with nonmusic students, questioning accepted wisdom on repetitive strain injuries.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12852675 10749-0712 Journal Article Review Review, Tutorial12852675_Hand Clinic, 30 Devonshire Street, London, W1G 6PU, United Kingdom. devonshireconsult@yahoo.comy?LSnedeker, J. P.2005,Adaptive engineering for musical instruments89-98&Medical Problems of Performing Artists202}Above-Knee Amputation Adolescence Adult Arthritis, Juvenile Rheumatoid *Assistive Technology Cerebral Palsy Cerebral Vascular Accident Diabetic Neuropathies *Disabled Equipment Design Female Finger Injuries Hand Deformities, Congenital Male Middle Age *Music Osteoarthritis Performing Artists Spinal Cord InjuriesOMusicians who become disabled may not necessarily need to discontinue music making. This article provides 12 examples of musicians for whom musical instruments were modified to accommodate specific disabilities. Ingenuity, imagination, and flexibility can help individuals with disabilities overcome obstacles to continue music making.~?M4Thompson, R. G. Moulin, C. J. Hayre, S. Jones, R. W.2005XMusic enhances category fluency in healthy older adults and Alzheimer's disease patients91-9 Exp Aging Res311Aged Aging/*psychology Alzheimer Disease/*psychology Analysis of Variance *Attention Case-Control Studies Female Humans Male *MusicJan-Mar|Exposure to some music, in particular classical music, has been reported to produce transient increases in cognitive performance. The authors investigated the effect of listening to an excerpt of Vivaldi's Four Seasons on category fluency in healthy older adult controls and Alzheimer's disease patients. In a counterbalanced repeated-measure design, participants completed two, 1-min category fluency tasks whilst listening to an excerpt of Vivaldi and two, 1-min category fluency tasks without music. The authors report a positive effect of music on category fluency, with performance in the music condition exceeding performance without music in both the healthy older adult control participants and the Alzheimer's disease patients. In keeping with previous reports, the authors conclude that music enhances attentional processes, and that this can be demonstrated in Alzheimer's disease.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15842075 D0361-073x Clinical Trial Journal Article Randomized Controlled Trial15842075NThe Research Institute for the Care of the Elderly, Bath, UK. rt204@bath.ac.uk~?NWarrington, J.2003@Hand therapy for the musician: instrument-focused rehabilitation 287-301, vii Hand Clin192Hand/physiopathology Hand Injuries/*rehabilitation Humans *Music Occupational Diseases/etiology/physiopathology/*rehabilitation Physical Therapy Techniques/instrumentation/*methods SplintsMaygExtraordinary hand therapy goals and treatment approaches are required for the professional musician. Rehabilitation using the instrument includes early return to modified playing, instrument-specific exercises, sensory reeducation and manual therapy, improving musical fitness, a multidisciplinary team approach, and instrument modifications and splinting when necessary. Education regarding good practice habits is essential to avoid secondary problems on return to full playing. This treatment approach is valuable following traumatic injury, for degenerative conditions, and for nonspecific wrist and hand pain.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12852671 10749-0712 Journal Article Review Review, Tutorial12852671^The Hand Clinic, 30 Devonshire Street, London, W1G 6PU, United Kingdom. j.warrington@tesco.net )?OAckermann, B.J. Adams, R.2005NFinger movement discrimination in focal hand dystonia: case study of a cellist77-81&Medical Problems of Performing Artists202Clinical Assessment Tools Data Analysis Software Descriptive Statistics *Dystonia/rh [Rehabilitation] *Fingers/ph [Physiology] Functional Assessment *Hand/pa [Pathology] Male Middle Age *Music *Occupational Diseases/rh [Rehabilitation] *Performing Artists Physical Examination Pilot Studies Pretest-Posttest Design *Proprioception Psychomotor Performance/ed [Education] *Psychophysiology ROC Curve Sensation/ev [Evaluation] Simulations Splints Therapeutic Exercise Instrumentation Candia dystonia evaluation scale. Tubiana and Chamagne evaluation scale.Focal hand dystonia in musicians has received increasing attention in recent years due to the debilitating and careerthreateningmnature of this condition. In cellists, focal hand dystonia is reported only infrequently in the existing literature, as compared to the rate in other instrumentalists, such as pianists and violinists. Although relatively less common, it has similarly devastating effects for those with this disorder. In the pilot study presented here, a 47-year-old male professional cellist experiencing left focal hand dystonia underwent pretests and posttests when he attended a 10-day period of intensive sensorimotor retraining. To monitor the effects of treatment, a pseudo-cello was designed that used the principles of psychophysical methodology to test active finger movement discrimination. This test was designed to evaluate whether this cellist could perceive the relative position of his left fingers in as task-specific a manner as possible. The pseudo-cello results showed a reduced ability to discriminate the height and tension of a string in the fingers most affected by the dystonia. Following the 10-day period of intensive physiotherapy, discrimination of finger movements had improved in the fingers that had been worked on with the rehabilitation program, and this corresponded with an improvement in the dystonia rating scale. The positive results obtained here suggest that this form of testing in focal hand dystonia warrants further research. ~?PVBlake, D. T. Byl, N. N. Cheung, S. Bedenbaugh, P. Nagarajan, S. Lamb, M. Merzenich, M.2002YSensory representation abnormalities that parallel focal hand dystonia in a primate model347-57Somatosens Mot Res194Animals Aotinae Brain Mapping Cerebral Cortex/*physiopathology Conditioning, Operant/physiology *Disease Models, Animal Dystonic Disorders/*physiopathology Face/innervation Hand/*innervation Hand Strength/physiology Humans Laterality/physiology Motor Neurons/physiology Nerve Net/physiopathology Research Support, U.S. Gov't, P.H.S. Somatosensory Cortex/physiopathology Stereotyped Behavior/physiology Thalamus/physiopathologyIn our hypothesis of focal dystonia, attended repetitive behaviors generate aberrant sensory representations. Those aberrant representations interfere with motor control. Abnormal motor control strengthens sensory abnormalities. The positive feedback loop reinforces the dystonic condition. Previous studies of primates with focal hand dystonia have demonstrated multi-digit or hairy-glabrous responses at single sites in area 3b, receptive fields that average ten times larger than normal, and high receptive field overlap as a function of horizontal distance. In this study, we strengthen and elaborate these findings. One animal was implanted with an array of microelectrodes that spanned the border between the face and digits. After the animal developed hand dystonia, responses in the initial hand representation increasingly responded to low threshold stimulation of the face in a columnar substitution. The hand-face border that is normally sharp became patchy and smeared over 1 mm of cortex within 6 weeks. Two more trained animals developed a focal hand dystonia variable in severity across the hand. Receptive field size, presence of multi-digit or hairy-glabrous receptive fields, and columnar overlap covaried with the animal's ability to use specific digits. A fourth animal performed the same behaviors without developing dystonia. Many of its physiological measures were similar to the dystonic animals, but receptive field overlap functions were minimally abnormal, and no sites shared response properties that are normally segregated such as hairy-glabrous combined fields, or multi-digit fields. Thalamic mapping demonstrated proportionate levels of abnormality in thalamic representations as were found in cortical representations.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12590836 !0899-0220 (Print) Journal Article12590836Coleman Laboratory, Keck Center for Integrative Neuroscience, and Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA. dblake@phy.ucs.edu c~?Q Byl, N. N.2003<What can we learn from animal models of focal hand dystonia?857-73Rev Neurol (Paris)15910 Pt 1OAnimals Aotinae Brain Mapping Conditioning, Operant/physiology Cytokines/metabolism Disease Models, Animal Dystonic Disorders/*physiopathology Electrophysiology Female Hand/*physiopathology/surgery Hand Strength/physiology Movement/physiology Psychomotor Performance/physiology Rats Rats, Sprague-Dawley Somatosensory Cortex/physiologyOct3Focal hand dystonia (FHd) is a disabling disorder of hand control characterized by a loss of inhibition and involuntary co-contractions of agonists and antagonists that can develop in motivated, productive individuals performing highly repetitive, intensive hand tasks. It is our hypothesis that FHd can result from aberrant learning. We summarize three behavioral animal models (Nancymae aotus owl monkeys and Sprague Dawley rats) that provide evidence supporting aberrant learning as one origin of FHd. Hand task behaviors that increase the risk for repetitive strain injury-FHd include: attended, precise, repetitive behaviors that involve near coincident inputs-outputs (e.g. rapid reversal of agonists-antagonists, stereotypical movements, stressful end range motions, cutaneous stimulation across broad surfaces). High force, vibration, congenital abnormalities, and stress can further increase the risk. The central consequences of aberrant learning include large sensory receptive fields (rfs), significant overlap of rfs across adjacent digits and across glabrous and dorsal surfaces, and the persistence of digital representations across a broad cortical distance (>600 microm). Behavioral animal models are valid for the study of FHd etiology and could logically be applied to study the effects of pharmaceutical, surgical, anatomical, and behavioral enrichment intervention strategies, but these models may have limitations in the study of the recovery of fine motor, articulated, interdigitated movements following progressive, learning based, complex sensorimotor training.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14615674 0035-3787 Journal Article14615674Department of Physical Therapy and Rehabilitation Science, School of Medicine, 1360 9th Ave. Box 0736, University of California, San Francisco, CA 942143-0736, USA. byl@itsa.ucsf.edu~?R Byl, N. N.2004<Focal hand dystonia may result from aberrant neuroplasticity19-28 Adv Neurol94 Discrimination Learning Dystonic Disorders/*etiology/therapy Electromyography/instrumentation/methods Evoked Potentials, Somatosensory/physiology *Hand Humans Motor Neuron Disease/*complications *Neuronal Plasticity Psychomotor Performance Somatosensory Cortex/physiology Space Perceptionfhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14509650 (0091-3952 (Print) Journal Article Review14509650Department of Physical Therapy and Rehabilitation Science, School of Medicine, University of California, San Francisco, California, USA. g~?SByl, N. N. McKenzie, A.2000Treatment effectiveness for patients with a history of repetitive hand use and focal hand dystonia: a planned, prospective follow-up study289-301 J Hand Ther1340Adult Cumulative Trauma Disorders/physiopathology/*rehabilitation Dystonic Disorders/physiopathology/*rehabilitation *Exercise Therapy Female Follow-Up Studies *Hand Humans Male Middle Aged Motor Skills *Music Occupational Diseases/*rehabilitation Prospective Studies Somatosensory Cortex/physiopathologyOct-Dec Recent studies show that rapid, nearly simultaneous, stereotypical repetitive fine motor movements can degrade the sensory representation of the hand and lead to a loss of normal motor control with a target task, referred to as occupational hand cramps or focal hand dystonia. The purpose of this prospective follow-up study was to determine whether symptomatic patients in jobs demanding high levels of repetition could be relieved of awkward, involuntary hand movements following sensory discriminative retraining complemented by a home program of sensory exercises, plus traditional posture, relaxation, mobilization, and fitness exercises. Twelve patients participated in the study. They all had occupational hand cramps, as diagnosed by a neurologist. Each patient was evaluated by a trained, independent research assistant before treatment and three to six months after treatment, by use of a battery of sensory, motor, physical, and functional performance tests. Care was provided by a physical therapist or a supervised physical therapist student in an outpatient clinic. Patients were asked to stop performing the target task and to come once a week for supervised treatment that included 1) heavy schedules of sensory training with and without biofeedback to restore the sensory representation of the hand, and 2) instructions in stress-free hand use, mirror imagery, mental rehearsal, and mental practice techniques designed to stop the abnormal movements and facilitate normal hand control. Patients were instructed in therapeutic exercises to be performed in the home to improve postural alignment, reduce neural tension, facilitate relaxation, and promote cardiopulmonary fitness. Following the defined treatment period, all patients were independent in activities of daily living, and all but one patient returned to work. Significant gains were documented in motor control, motor accuracy; sensory discrimination, and physical performance (range of motion, strength, posture, and balance). This descriptive study that includes patients with occupation-related focal hand dystonia provides evidence that aggressive sensory discriminative training complemented by traditional fitness exercises to facilitate musculoskeletal health can improve sensory processing and motor control of the hand.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11129254 !0894-1130 (Print) Journal Article11129254Department of Physical Therapy and Rehabilitation Science, UCSF/SFSU Graduate Program in Physical Therapy, University of California-San Francisco, 94143, USA. byl@itsa.ucsf.edu #~?T(Byl, N. N. McKenzie, A. Nagarajan, S. S.2000yDifferences in somatosensory hand organization in a healthy flutist and a flutist with focal hand dystonia: a case report302-9 J Hand Ther1341Adult Comparative Study Cumulative Trauma Disorders/*physiopathology Dystonic Disorders/*physiopathology Evoked Potentials, Somatosensory Female Humans *Music Occupational Diseases/*physiopathology Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Somatosensory Cortex/*physiopathologyOct-DecFocal hand dystonia is a disabling, involuntary disorder of movement that can disrupt a successful musician's career. This problem is difficult to treat, to some extent because we do not fully understand its origin. Somatosensory degradation has been proposed as one etiology. The purpose of this case study was to compare the differences in the somatosensory hand representation of two female flutists, one with focal dystonia of the left hand (digits 4 and 5) and one a healthy subject (the control). Noninvasive magnetic source imaging was performed on both subjects. The somatosensory evoked potentials of controlled taps to the fingers were measured with a 37-channel biomagnetometer and reported in terms of the neuronal organization, latency, amplitude, density, location, and spread of the digits on each axis (x, y, and z). The somatosensory representation of the involved hand of the flutist with dystonia differed from that of the healthy flutist. The magnetic fields evoked from the primary somatosensory cortex had a disorganized pattern of firing, with a short latency and excessive amplitude in the involved digits of the affected hand, as well as inconsistency (decreased density). In addition, the patterns of firing were different in terms of the location of the digits on the x, y, and z axes and sequential organization of the digits. This study confirms that somatosensory evoked magnetic fields can be used to describe the representation of the hand on the somatosensory cortex in area 3b. Degradation in the hand representation of the flutist with focal hand dystonia was evident, compared with the hand representation of the healthy flutist. It is not clear whether the sensory degradation was the cause or the consequence of the dystonia. The questions are whether re-differentiation of the representation could be achieved with aggressive sensory retraining and whether improvement in structure would be correlated with improvement in function.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11129255 .0894-1130 (Print) Case Reports Journal Article11129255Department of Physical Therapy and Rehabilitation Science, UCSF/SFSU Graduate Program in Physical Therapy, University of California-San Francisco, 94143, USA. byl@itsa.ucsf.edu I?VHCandia, Victor Rosset-Llobet, Jaume Elbert, Thomas Pascual-Leone, Alvaro2005?Changing the brain through therapy for musicians' hand dystonia335-342*Annals Of The New York Academy Of Sciences1060Focal hand dystonia is a disorder in which sensory and motor anomalies emerge that appear to be grounded in maladaptive routes of cortical plasticity. Remodeling cortical networks through sensory-motor retuning (SMR), we achieved long-term reduction in the symptoms of focal hand dystonia. Magnetoencephalography confirmed that SMR modified the representational cortex of the fingers, whereby the representation of the affected hand was reorganized so that it resembled more the organization of the non-affected side. Furthermore, we observed differences in abnormal tactile acuity between patients with musician's cramp and those with writer's cramp: Using two-point finger discrimination, dystonic musicians showed perceptual asymmetry between hands, while writer's cramp patients did not. To further evaluate the occurrence of collateral disturbances in focal dystonia, we assessed the clinical histories of 101 affected musicians. An important finding from this study was that dystonic musicians who play a similar first and second instrument reported a continuous worsening of their symptoms. In addition, collateral disturbances appeared with a shorter delay when more than one instrument was played. Taken together, these studies suggest that (1) neurological dysfunction can be reversed by context-specific training protocols, (2) specific symptomatic and etiological differences among various forms of focal hand dystonia might result from different behavioral experiences and their central representation, and (3) the spread of symptoms might be prevented by avoiding training that implies movement patterns similar to the main affected task, and by reducing the amount of task-associated movement behavior.Dhttp://search.epnet.com/login.aspx?direct=true&db=cmedm&an=16597783 Accession Number: 16597783 Language: English. Date Created: 20060406. Update Code: 20060410. Publication Type: Journal Article. Journal ID: 7506858. Publication Model: Print. Cited Medium: Print. NLM ISO Abbr: Ann. N. Y. Acad. Sci. 0077-8923vCollegium Helveticum ETH-Zentrum/STW, Schmelzbergstrasse 25, CH-8092 Zürich, Switzerland. candia@collegium.ethz.ch.pf`~?W;Hirata, Y. Schulz, M. Altenmuller, E. Elbert, T. Pantev, C.2004QSensory mapping of lip representation in brass musicians with embouchure dystonia815-8 Neuroreport155QAdult Analysis of Variance Case-Control Studies Comparative Study Copper Fingers/physiology Humans Lip/*physiopathology Magnetoencephalography/methods Male Meige Syndrome/*physiopathology *Music Research Support, Non-U.S. Gov't Sensory Thresholds/*physiology Somatosensory Cortex/pathology/*physiopathology Statistics, Nonparametric ZincApr 9DEmbouchure dystonia is a focal task-specific disorder involving abnormal non-coordinated movements and involuntary muscle contraction around the mouth. In professional brass players it is often so disabling that patients have to limit or give up their occupation. We examined the somatosensory homuncular representation and measured gap detection sensitivity of the lips in eight former professional musicians affected by embouchure dystonia and eight control subjects. Relative to controls, the patients' digit, and especially the thumb, representations were shifted in a lateral direction towards the lip representational zone. Patients' upper lips showed decreased sensitivity compared to their lower lips (p < 0.01). This asymmetry result was absent in controls. Abnormal somatosensory reorganization may contribute to the disorder.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15073521 0959-4965 Journal Article15073521wInstitute of Biomagnetism and Biosignalanalysis, Munster University Hospital, Munster, Germany. hirata@es.hokudai.ac.jp H?XgIltis, P.W. Givens, M.W.2005fEMG characterization of embouchure muscle activity: reliability and application to embouchure dystonia25-34&Medical Problems of Performing Artists201The purpose of the study was to develop a method to quantitatively and qualitatively describe the activity of selected muscles of the embouchure in French horn players using surface electromyography (EMG). Also, the reliability of several dependent variables that may be useful in future studies of embouchure dystonia (ED) was assessed. Five volunteers, including four normal French hornists (two male, two female) and one performer with ED performed two standardized tasks on two different occasions. The first task consisted of playing four iterations of two notes, one that elicited tremor in the ED subject and one that did not. This was followed by a 60-sec fatigue trial on the nontremor note. The levator labii and depressor anguli oris muscles were instrumented with miniature surface electrodes, and a microphone within a mute allowed audio signals from the horn to be simultaneously recorded. The presence of tremor was uniquely identified in the ED subject using EMG, and continuous wavelet transformation scalogram comparisons indicated temporal differences in signal power ([micro]V2/Hz) as well as in the dominant frequency range. Within-trial reliability for amplitude, mean and median frequency, zero crossings, and power was excellent (r >= 0.977) for both muscles on the first performance task. Between-session reliability ranged from fair to good (r = 0.677[inverted question mark]0.898) on these same variables. Numerous other variables associated with the fatigue task also showed good to high reliability (r = 0.90[inverted question mark]0.99) between testing sessions. The findings suggest that the simple testing protocol presented may be of use in future studies of ED.gDept of Movement Science, Gordon College, 255 Grapevine Road, Wenham, MA 01984; Iltis@faith.gordon.edu.~?YCJabusch, H. C. Zschucke, D. Schmidt, A. Schuele, S. Altenmuller, E.2005WFocal dystonia in musicians: treatment strategies and long-term outcome in 144 patients1623-6 Mov Disord2012,Adult Anti-Dyskinesia Agents/therapeutic use Botulinum Toxins/therapeutic use Combined Modality Therapy Comparative Study Disability Evaluation Dystonic Disorders/*rehabilitation/*therapy Exercise Therapy/methods Female Humans Longitudinal Studies Male *Music Retrospective Studies *Treatment OutcomeDeclWe present the long-term outcome of 144 musicians with focal dystonia after treatment with botulinum toxin (n = 71), trihexiphenidyl (n = 69), pedagogical retraining (n = 24), ergonomic changes (n = 51), or nonspecific exercises on the instrument (n = 78). Outcome was assessed by patients' subjective rating of cumulative treatment response and response to individual therapies. Seventy-seven patients (54%) reported an alleviation of symptoms: 33% of the patients with trihexiphenidyl, 49% with botulinum toxin, 50% with pedagogical retraining, 56% with unmonitored technical exercises, and 63% with ergonomic changes.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=16078237 00885-3185 (Print) Clinical Trial Journal Article16078237hInstitute of Music Physiology and Musicians' Medicine, University of Music and Drama, Hannover, Germany.?ZHLederman, R.J.2004Drummers' dystonia70-4&Medical Problems of Performing Artists192SSeveral reviews involving large numbers of instrumental musicians with focal dystonia from centers in the United States and Europe are available in the performing arts medicine literature, but only a relatively few percussionists have been included. This article describes 6 percussion instrumentalists, out of a total of 139 musicians with dystonia, seen in the Cleveland Clinic Medical Center for Performing Artists. The five men and one woman ranged in age from 21 to 51 years at the onset of dystonia; four were playing professionally, and two were students. Duration of symptoms at the time of evaluation ranged from 1 to 10 years, although five of six were seen 3 years or less after onset. Three were primarily classical percussionists, two played mainly jazz or rock, and one played country music. Two of the six were left-handed; dystonia affected the right arm in three, the left in two, and the left more than the right in one. The nondominant limb was affected solely or predominantly in five of six. Dystonia affected primarily the forearm and wrist, rather than the digits, in contrast to most keyboard, string, and woodwind instrumentalists, presumably reflecting the relative stresses of repetitive movements in this group. A variety of treatment modalities were used before and after evaluation. Of the three musicians still actively playing, one uses anticholinergic medication before each performance, one has restricted her playing to mallet instruments, and one has had a favorable response to limb immobilization. Two others remain in music, teaching or conducting; one has been lost to follow-up.~Department of Neurology and Medical Center for Performing Artists, Cleveland Clinic Foundation, Cleveland, OH; ledermr@ccf.org~?[:Lim, V. K. Bradshaw, J. L. Nicholls, M. E. Altenmuller, E.2004@Abnormal sensorimotor processing in pianists with focal dystonia267-73 Adv Neurol94Adult Aged Brain Mapping Comparative Study Contingent Negative Variation/physiology Dystonic Disorders/*physiopathology Electroencephalography/instrumentation/methods Electromyography/instrumentation/methods Humans Male Middle Aged Movement/physiology Movement Disorders/physiopathology *Music Physical Stimulation Reaction Time Research Support, Non-U.S. Gov't Somatosensory Cortex/*abnormalitiesFocal dystonia is a task-specific sensorimotor disorder that is characterized by sustained muscle contractions, which may cause twisting, repetitive movements, or abnormal postures. In the current study, the contingent negative variation was recorded in a group of professional pianists with focal dystonia (musicians' cramp) and compared to pianist controls. The CNV is composed of an early stimulus processing component and a later response preparation component. The CNV can be elicited in tasks that require movement and nonmovement. A subtractive analysis with a nonmovement condition was used to minimize effects of the CNV not related to response preparation. The current results revealed no group differences for the early CNV (processing of stimulus properties). In contrast, a significant group difference was found in the late CNV (movement preparation) between patients and controls, with the patients showing significantly higher activation prior to movement. The current study demonstrates an increase in overall sensorimotor activity prior to movement in patients with musicians' cramp. This overexcitation of the cortex may be the result of a dysfunction in the globus pallidus, resulting in a lack of inhibition and/or an increase in excitation.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14509684 0091-3952 Journal Article14509684XDepartment of Sport and Exercise Science, University of Auckland, Auckland, New Zealand.~?\KMcKenzie, A. L. Nagarajan, S. S. Roberts, T. P. Merzenich, M. M. Byl, N. N.2003hSomatosensory representation of the digits and clinical performance in patients with focal hand dystonia737-49Am J Phys Med Rehabil8210Adult Case-Control Studies Dystonia/*physiopathology Evoked Potentials, Motor/physiology Evoked Potentials, Somatosensory/*physiology Female Hand/*physiopathology Humans Magnetoencephalography Male Middle Aged Movement Disorders/*physiopathology Prospective Studies Psychomotor Performance/physiology Quality of Life Range of Motion, Articular Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Somatosensory Cortex/*physiopathologyOct!OBJECTIVE: The purpose of this study was to incorporate magnetoencephalography and clinical testing to describe differences in somatosensory organization and sensorimotor function of the hand in patients with focal hand dystonia, a target-specific disorder of voluntary movement that interferes with fine motor control during the performance of rapid, repetitive, skilled movements. DESIGN: This descriptive study included prospective, quasi-experimental comparisons between groups. RESULTS: Patients with focal hand dystonia demonstrated deficits in physical variables, sensory processing, and motor control when compared with age- and sex-matched controls. They also had altered patterns of firing (amplitude and latency integrated over time) and abnormal somatosensory representations on magnetoencephalography. CONCLUSIONS: These study findings suggest that there are alterations in both somatosensory representation of the digits and clinical performance in patients with focal hand dystonia. Future studies to determine if alterations in the sensorimotor feedback loop contribute to the development of focal hand dystonia are indicated. If so, intervention strategies may need to include specific types of somatosensory retraining as part of the rehabilitation program for patients with focal hand dystonia.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=14508403 !0894-9115 (Print) Journal Article14508403RDepartment of Physical Therapy, Chapman University, Orange, California 92866, USA.?]aRodríguez, Alfonso Vargas Kooh, Min Guerra, Luis Amezcua Martínez-Lavín, Manuel Pineda, Carlos20055Musician's cramp: a case report and literature review274-276[Journal Of Clinical Rheumatology: Practical Reports On Rheumatic & Musculoskeletal Diseases11 5 (Print)Music* Dystonic Disorders/*diagnosis Occupational Diseases/*diagnosis Diagnostic Errors Electromyography Forearm Humans Lipomatosis/diagnosis Male Middle Aged Soft Tissue Neoplasms/diagnosis4Musician's focal dystonia is a motor dysfunction that appears in artists after years of repetitive and fine movements during performance. This is the condition most feared by musicians because it leads to difficulties in controlling movements, which can interrupt or terminate their careers. It is characterized by the onset of involuntary muscle contractions and movements; its distinguishing feature is that it only occurs during a specific and well-defined action. It is rarely diagnosed because those who experience it do not seek medical attention for fear or shame, but also because many physicians do not consider the disease in the differential diagnosis of motor dysfunction. We describe the case of a guitarist who presented to our outpatient clinic after many years of experiencing musician's focal dystonia. He reported a long list of misdiagnoses and a variety of unsuccessful treatments.Musician's focal dystonia is an under-diagnosed condition. Treatment benefit is limited despite recent innovative approaches. Rheumatologist should be aware of this condition.Dhttp://search.epnet.com/login.aspx?direct=true&db=cmedm&an=16357776 Accession Number: 16357776 Language: English. Date Created: 20051216. Date Completed: 20060207. Update Code: 20060208. Publication Type: Case Reports; Journal Article. Journal ID: 9518034. Publication Model: Print. Cited Medium: Print 1076-1608HInstituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.?^8Rosenkranz, K. Altenmuller, E. Siggelkow, S. Dengler, R.2000_Alteration of sensorimotor integration in musician's cramp: impaired focusing of proprioception 2040-2045Clinical Neurophysiology 11111Music* Muscle Cramp/*physiopathology Muscles/*physiopathology Brain/physiology Evoked Potentials, Motor/physiology Humans Research Support, Non-U.S. Gov't Vibration^OBJECTIVE: The influence of muscle vibration (MV) as a strong proprioceptive input on motorcortical excitability was studied in 5 patients with musician's cramp, 5 musician controls and 5 non-musician controls. METHODS: The relaxed flexor carpi radialis (FCR), involved in the dystonic movement in all patients, was vibrated using low frequency (80 Hz) and low amplitude (0.5 mm). Transcranial magnetic stimulation (TMS; intensity, 120% of motor threshold) was applied without MV, 3 and 9 s after the onset of MV. Motor-evoked potentials (MEPs) in the FCR and in the antagonistic extensor carpi radialis (ECR) were recorded. RESULTS: With MV, musician and non-musician controls showed a facilitation of MEPs in the FCR and a decrease of MEPs in the ECR. In musician's cramp, both phenomena were significantly less pronounced. CONCLUSIONS: The reduced facilitation of MEPs in musician's cramp indicates a reduced MV-induced activation of motorcortical areas representing the FCR. The less pronounced inhibition by MV reflects a reduced inhibitory control of the antagonistic ECR. As there were no differences between musician and non-musician controls, the observed changes in musician's cramp refer to this special form of focal dystonia. An impairment of focused motorcortical activation by proprioceptive input from a muscle involved in the dystonic movement is suggested.Dhttp://search.epnet.com/login.aspx?direct=true&db=cmedm&an=11068240 Accession Number: 11068240 Language: English. Date Revised: 20041117. Date Created: 20001215. Date Completed: 20010111. Update Code: 20051225. Publication Type: Journal Article. Journal ID: 100883319. Publication Model: Print. Cited Medium: Print 1388-2457KDepartment of Neurology, Medical School Hannover, 30623, Hannover, Germany.~?_:Schuele, S. Jabusch, H. C. Lederman, R. J. Altenmuller, E.2005BBotulinum toxin injections in the treatment of musician's dystonia341-3 Neurology642Jan 25The authors present the results of 84 musicians with focal task-specific dystonia treated with EMG-guided botulinum toxin injections. Treatment outcome was assessed by subjective estimation of playing before and after treatment and self-rating of treatment response. Fifty-eight (69%) of the musicians experienced improvement from the injections and 30 of 84 musicians (36%) reported long-term benefit in their performance ability.fhttp://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=15668436 1526-632x Journal Article15668436Department of Neurology and Medical Center for Performing Artists/Mailbox S 432, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA. schules@ccf.org?`%Schuele, Stephan Lederman, Richard J.2004>Long-term outcome of focal dystonia in string instrumentalists43-48Movement Disorders19 1 (Print)qMusic* Dystonic Disorders/*diagnosis Occupational Diseases/*diagnosis Adult Aged Combined Modality Therapy Comparative Study Disability Evaluation Dystonic Disorders/rehabilitation Female Follow-Up Studies Humans Male Middle Aged Neurologic Examination Occupational Diseases/rehabilitation Outcome and Process Assessment (Health Care) Posture Rehabilitation, VocationalThis study describes the clinical characteristics and long-term outcome in string instrumentalists with focal task-specific dystonia. We present the results of a follow-up telephone survey of 21 violin and viola players with focal dystonia. Eighteen musicians responded to the questionnaire. Information on long-term outcome was available on average 13.8 years after onset of symptoms. Main complaints were playing-related loss of control and involuntary movements affecting the fingering hand in 16 and the bow arm in 5 patients. In 18 patients (86%), signs of abnormal posture could be detected by watching them play their instrument. Treatment attempts included nerve decompression, physical therapy, retraining, and anticholinergic medication. In selected patients, botulinum toxin injections or splint devices were offered. Only 38% of the performing artists were able to maintain their professional careers, among them none with bow arm dystonia. Focal dystonia may affect the fingering hand or bow arm in violin and viola instrumentalists. Treatment benefit is limited and in more than half of the patients, dystonia leads to the end of their musical career. (Copyright 2003 Movement Disorder Society)Dhttp://search.epnet.com/login.aspx?direct=true&db=cmedm&an=14743359 Accession Number: 14743359 Language: English. Date Revised: 20041117. Date Created: 20040126. Date Completed: 20040831. Update Code: 20051227. Publication Type: Journal Article. Journal ID: 8610688. Publication Model: Print. Cited Medium: Print. NLM ISO Abbr: Mov. Disord. 0885-3185Department of Neurology and Medical Center for Performing Artists, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA. schules@ccf.org