Making an Ergonomic Holder for eReader Tablets for Piano

M y wife gave me a Samsung Galaxy Tab 10.1 Android tablet for my birthday. I use it for lots of things, but one of its best purposes is as a music reader on our piano.

A irTurn’s Bluetooth-based BT-105 is out--it has many nice, new features.

F or the BT-105, I've used an inexpensive Levenger Dovetail bookstand as a cradle, accessorized with a bit of Sugru® silicone to keep the tablet or the cradle from moving around with the vibration from vigorous playing/pedaling. I use that mostly with our MIDI keyboard.

B ut I still like and use my original AT-104 with its proprietary RF communication between the pedal transmitter and the USB dongle receiver. For one thing, there are no long-range Bluetooth interference/security issues with the AT-104.

T he 1280x800 pixel resolution of the 10.1-inch Widescreen HD WXGA TFT on the Galaxy is noticeably better than the 1024x768 resolution of the iPad 2’s 9.7-inch screen. (The screen on the Samsung tab has a 16:9 aspect ratio, compared to 4:3 on the iPad 2. In the landscape orientation, which is how I position the tablet on the piano music stand, the Galaxy display is only 4% more pixels vertically, but it’s got 25% more res than the iPad 2 horizontally.)

S o if I’m going to stick with my AT-104 AirTurn, then I need to get the USB receiver dongle attached to the Galaxy Tab, and the USB port is at middle of the bottom edge of the tablet. (I could rotate the Tab 180-degrees to be upside-down, so the USB port is on top. But then I’d have an unsightly dongle or pigtail cable coming out up there.)

T he Samsung USB adapter dongle is okay, but it sticks out 3cm beyond the edge of the tablet, and a male USB connector terminating a typical cable-end sticks out 5cm beyond that. You need some way to elevate the tablet about 10cm for the short male-to-female USB passthru/extender cable to the AirTurn Dongle to connect to the Samsung USB dongle.

E levating the tablet that much is actually an improvement in terms of good visual ergonomics. But you need to keep the tablet secure and level in that position.

A nd there’s another issue—which is the same as the issue that's affected the usability of laptop-based music eReaders for pianists: the front-to-back depth. It may be too deep for some piano music stands. And it’s definitely too deep for harpsichord or organ music stands. Or the rail on the music stand that is fine for 60 gm of paper sheetmusic is too wimpy for a shiny, slippery tablet that weighs 600 gm. There is a significant risk that the tablet will shimmy its way to a bad fall.

A  further issue for me, at least, is the visually small form-factor of the tablet--specifically, the fact that the active display area of the 10.1-inch screen comes so close to the edge of the device—makes me want to have slightly wider “margins” framing the visual field that I’m looking at. With the tablet on the Dovetail bookstand, the “near-far” field at the left-hand and right-hand edge of the displayed music interferes with my eyes’ focus. Maybe that is not an issue for you, but it is for me.

S o I cut a 12x14-inch piece of black 3/16-inch Delrin acetal, put some 1/2-inch Delrin brackets on it with Sugru® to cushion them (see photo). You slide the tablet into the lower brackets and press the top edge in past the pan-head “crowns” of the 3 Sugru® bumpers--each one is about 1 mL of Sugru® that is molded to stand proud of the 5/16-inch hole by about 0.03-inch. The Sugru® is just the right Shore-A/durometer hardness to “give” just a little as the tablet edge moves inward and seats flat against the acetal sheet. The mechanical “detent” of the Sugru® is just enough to hold the tablet securely in place but still allow the tablet to be easily plucked out again with gentle finger force.


M y kluged black acetal stand leaves a nice visual margin all around, similar to the whitespace from the staves to the edges of normal sheetmusic paper, in the same focal plane as the image on the tablet. It makes it easier to read the Tab’s display, and it’s compatible with any piano, organ, harpsichord, etc., including ones that have only a tiny, narrow rail/groove for music to stand up in.

H ugh Sung’s Airturn site has plenty of nice stands and brackets to hold tablets and laptops on various types of mic stands or other uprights. Those are great for string players, wind instruments, singers, and other kinds of musicians. But if you’re a pianist and you’ve done ‘home-brew’ things yourself, to enhance the mounting of your tablet on your piano's music stand, please leave a comment below or email me!

• Sugru.com
  
• AirTurn.com
  
• Musicnotes.com
  
• Galaxy Tab 10.1 USB adapter
  
• Levenger Dovetail bookstand
  
• SmallParts.com
  
• DSM. Assistive technologies for musicians. CMT blog, 09-DEC-2008.
  
• SIL.org LinguaLinks principles of book design for ease-of-use: Setting margins. 1999.
  
• Youngman M, Scharff L. Text width and margin width influences on readability of GUIs. Southwest Psychol Assoc, 1998.
  
• Zetter K. Security cavities ail Bluetooth. Wired, 06-AUG-2004.
  
• Ziefel M. Effects of display resolution on visual performance. Human Factors 1998;40:555-68.
  
• Lookout security system for iPad and Android tablets [$30/yr subscription]
  
• AndroidCentral forum post about lack of music reader apps on Android, as of 15-JUL-2011
  
• MusicReader still lagging re: support for Android devices

Afflicted Fingerings, Biomechanics, and Energy Budgets

B    and B-flat, vying; then C and C#: yow! … all of which as if to reveal some hidden perversity in the interval itself, to show some concealed possible corner of the second’s personality … what the Second does when he’s at home alone, when no one’s watching.”
  —  Jeremy Denk, More about Goldberg Variations, ThinkDenk blog, 11-MAY-2009.

M y hand shifts to make a gradual transition in this Bach sarabande. I never fail to be impressed by how deeply afflicted this piece is. I think of these passages as several competing storylines crossing each other... chains upon [Dutilleux-esque] chains of expressive dissonances in the French Suites.


W hat fingerings might be best? Bach’s Inventions No. 1 and 2 have been the focus for studies by Yuichiro Yonebayashi, Hirokazu Kameoka, and Shigeki Sagayama at the University of Tokyo (link below). They represent the positions and forms of hands and fingers as Hidden Markov Model (HMM) states and model the resulting sequence of performed notes mathematically as HMM transitions. Or, for me just now, Bach’s French Suites, BWV 812-817, Markovian fingers, compelled by what other neighboring Markovian fingers just did.

F    ingering would be no problem were it not that music notes are preceded and/or followed by other notes.”
  —  Yuichiro Yonebayashi, Hirokazu Kameoka, and Shigeki Sagayama.

O ptimal fingering is essentially a problem of finding an optimal sequence of [reasonably] smooth state-transitions, from one state of each finger to the next. But the issue is not just about ‘ease’ or ‘reliability’ or ‘evenness’, even though those are of course important. The matter has also to do with texture and emotion. In fact, a thoughtful composer who is also a pianist knows very well what biomechanical ‘cost function’ or budget for effort or attention or energy expenditure will likely prevail for performers. If the composer’s intent is to devise an especially afflicted expression, then the composer chooses a key-signature and sequences of notes specifically with the intention of beleaguering or defeating performers’ biomechanics cost functions and built-in instincts.

W    hen pianos were first invented, they were similar in size to harpsichords. Hand size was rarely a limiting factor throughout the eighteenth century because the keys were short and narrow and the repertoire usually contained intervals no larger than the octave. However, at the beginning of the nineteenth century, the piano gradually expanded in range and key size. The use of cast iron frames led to an exponential increase in string tension, resulting in heavier and deeper actions that exacerbated problems for small-handed players. Nineteenth-century concert pianos typically featured actions with 6 millimeters of travel depth, requiring 23 gm of weight for full key depression and string tension in the middle register that ranged from 12 to 15 grams. By the end of the century, string tension had risen to 80 kg in the middle register, resulting in a heavier action with 9 mm of travel depth, requiring 45 g for full key depression. Today’s Steinway grands feature even heavier actions and larger hammers: 90 kg of string tension and 10.5 mm of travel depth, requiring 50 to 60 g of key depression force.”
  —  Lora Deahl & Brenda Wristen, American Music Teacher, JUN-2003.

I  sometimes use 2-3-5 LH for triads and 1-2-3 for RH triads, leaving the thumb ready for 7ths or other contingencies. Also, my RH likes 1-3-5 or 1-2-5 when straddling black notes or for inversions or big gaps. But these produce tension in the hand—not just physical stretching but—I realize this now—brain stretching, too. Brain regions controlling the index finger and middle finger—fused under the influence of years of neuroplasticity—get anxious. They are apprehensive of more affliction that’s surely in-store.

T his Bach is undoubtedly about middle age and loss. Written in 1722 or a little earlier—two years after the sudden death of his first wife, Maria Barbara; now soon after his marriage to Anna Magdalena. Bach at 37—he hardly knew over-the-hillness first-hand, but he surely knew about loss. I realize that I am playing this differently now in my late 50s than I did 20 years ago, but I am not sure how to explain the difference in words.

I t has been more than 10 years since I played French Suites. The elapsed time is long enough to have lost any muscle memory I once had. Whole strategies and insights have vanished—and my old marked-up copy misplaced in one move or another along the way. Maybe my explanation for what is different is just that: beginning again, after some sort of catastrophe. Feels like physical therapy/rehab for someone who has suffered a stroke? You full-well know what your appendages ought to do, and you know the self-possessed sensations that you intend, but the body doesn’t cooperate—or even feel like your own self, really.

W hen working out your fingerings—even for a piece that is vexingly familiar and yet alien, like this one is for me right now—you often start at the beginning of a passage and plot your strategy forward from there. Sometimes, though, I prefer to first find the points that demand a specific finger. These points mark constraints such that you must have the requisite finger to proceed into the next phrase; such points are often the highest or lowest points in a passage. In the RH, you don’t usually want to end up with fingers 1 or 2 on the highest note (LH lowest note), nor do you want to end up on 4 or 5 on the lowest note of a RH passage (highest in the LH)—especially if the thing is going to immediately reverse direction. Once you’ve identified those constraints, you can work outward, both upstream and downstream, to plan your optimal fingerings.

I  mark each place that involves a finger substitution, a change of fingering on a repeated note, or crossings (4-over-5; 2-over-1; 3-over-1; 4-over-1; 1-under-2; 1-under-3; 1-under-4; 5-under-4). I used to do this in pencil, and sometimes I still do this. But in the last couple of years I prefer to do it with e-markups in MusicReader™ software, which I use with my AirTurn™ pedal.

I  mark more non-standard fingerings—the more afflicted the passage, the more non-standard it gets. For example, a passage may have a D minor scale in the RH, but it may continue to the octave E. One conventional fingering would cross to 1 on the high D and place 2 on the E. If it were then to return, you would have another crossing (1 - 4 on D to C) almost immediately. In this instance, a non-standard fingering such as 1-2-3-4-1-2-3-4 may be more effective. Bach as ‘rehab’; rehab as [self-] ‘discovery’...

• Dunning J. When a pianist’s fingers fail to obey. NY Times, 14-JUN-1981.
  
• Ferrario V, et al. Three-dimensional analysis of hand and finger movements during piano playing. Med Prob Perf Artists 2007;22:18-24.
  
• Harding D, et al. Minimization of finger-joint forces and tendon tensions in pianists. Med Prob Perf Artists 1989;4:103-7.
  
• Miyoshi A. Piano Method, Vols. 1-8. Kawai Press, 1998.
  
• Akiro Miyoshi page at Wikipedia
  
• Wristen B. Avoiding piano-related injury: A proposed theoretical procedure for biomechanical analysis of piano technique. Med Prob Perf Artists 2000;15:55-63.
  
• Yonebayashi Y, et al. Automatic decision of piano fingering based on hidden Markov models. Proceedings IJCAI 2007, Pp. 2915-21. [1MB pdf]
  
• Music Teachers National Association (U.S.)
  
• American Academy of Physical Medicine & Rehabilitation
  
• Performing Arts Medicine Association

Nicholas Kitchen, Whale Rider

A   s I began to learn these Sonatas and Partitas when I was young, I first looked at this one and I thought of it as a great, white, snow-capped mountain. And, then, here was another wonderful white mountain. And another one… Six beautiful white mountains. But with the passing years and as my understanding of them grew—as I was able to stand back and benefit from the perspective—I came to see them in a new light. The glistening white violin Sonatas and Partitas [BWV 1001-1006] are like the white callosities on the head of a giant whale. What Bach created in these works is far bigger [than we might first imagine, or than we can ever really fathom]. Each is a part of one giant, living thing.”
  —  Nicholas Kitchen, pre-concert remarks, Park University, 19-FEB-2009.

O    n the east coast of New Zealand, the Whangara people believe their presence there dates back a thousand years or more to a single ancestor, named Paikea, who escaped death when his canoe capsized by riding to shore on the back of a whale.”
  —  Whale Rider, 2003.

I t was exquisite and devastating, Nicholas Kitchen’s performance of the Bach violin Sonatas and Partitas last evening, the culmination of a series of lectures and master-classes he had given over several days at Park University in Kansas City. The scope and scale of the 3-hour-plus concert were tremendous; the staggering panoramic beauty, pathos, and joy of it—these pieces that are so seldom heard all in one sitting.

K itchen’s thoughtful remarks prior to commencing each Sonata-Partita pair were almost as delightful as his playing. A further treat for us in the audience was to read as the pages of Bach’s original score were projected on a large screen behind Kitchen, as he played from a chest-high tripod-mounted laptop PC controlled by a foot-pedal-actuated Page/ScoreTurner.


F or ‘historically-informed performance’ (HIP) buffs, the experience was even more deeply fulfilling and illuminating because of this feature. The digitized Bach manuscript flowed by. Kitchen gently tapped the left-hand pedal button to return up-page for the repeats. We saw on the projection screen each and every one of Kitchen’s decisions in real-time, on-the-fly: his interpretations of every trill and mordent; his judgments about every appoggiatura—everything.

T he fluid lines and elegance of Bach’s own hand—the wavy thirty-second-note beaming; the capricious, dashed slurs and ligatures, whose agile ink-shapes belie Bach’s certitude and exuberance while his almighty pen flew across the manuscript paper: the music is ever so much more alive when we see this! For Kitchen to use the laptop and real-time m.s. projection in a concert performance was a gesture of great daring and generosity—especially for the many Conservatory professors and students in the audience. (Pray that MSwindows/MacOS does not crash! Pray that there is no electrical surge from a passing thunderstorm!) Hell, the feat that Kitchen accomplished was a soul-baring tour-de-force, the likes of which I had never seen before. It was like seeing the live video feed from a mountain-climber tackling K2, wearing a helmet-cam during the ascent. If ever a performance were to merit a standing ovation, this was it!


I n the past I’ve heard Nicholas perform as a member of the Borromeo Quartet, but in that ensemble setting I’d never adequately heard the delicacy of his technique nor comprehended the nuances of his interpretations—purely a limitation of my hearing acuity and of my attention, not a fault of Borromeos. The 1730 ‘Baron Vita’ Goldberg ‘Guarneri del Gesú’ does allow a range of gorgeous possibilities. And these Sonatas and Partitas do admit a wide range of emotional topography to cover. But this! The prodigious polyphony and multi-stopping. The louré/portato/cantabile that articulates each note without a hitch! The arpeggiati: traversing extreme rock and ice, solo, without a belayer. The ornamentation-world-without-end, amen. Desolation in minor keys, beyond any you have known. Joy in C major and E major, enough to heal almost anything. OMG. An air-tight exposition of the eternal dichotomy of Fate and human empowerment: how can they co-exist?

Y ou’re inexplicably caught up by a strong musical ‘current’ that pulls you into its emotional ‘undertow’ for three hours straight. You go ahead: you give in to it; you let go! You go with the Whale! If you count 16^th notes “one-ee-and-ah, two-ee-and-ah”, most melody notes occur on ‘numerals’, not on ‘ands’. But in these Sonatas and Partitas we hear Bach (and Kitchen) pushing the melodic line onto ‘ands’, for the sheer effect that it has. Multiple lines—a solo instrument, manifesting multiple vocal lines and multi-voice leading simultaneously—especially with double-, triple- and quadruple-stops. One voice on the numeral-labeled downbeats; the other voice on upbeats. The ear and the mind follow each. The spontaneous effect is to cause us to recognize our own inner-voice/conscience, in dialogue with our conscious ego. Neither has a dominance or superior power; both are legitimate and necessary parts/aspects of the ‘whole’ self. At least that’s what Kitchen’s interpretation of Bach’s figuration does to me as I listen… Maybe you, too.

• Sonata No. 1 in G minor, BWV 1001 (Adagio; Fuga [allegro]; Siciliano; Presto)
  
• Partita No. 1 in B minor, BWV 1002 (Allemanda; Double; Corrente; Double; Sarabande; Double; Tempo di Bourée; Double)
  
• Sonata No. 2 in A minor, BWV 1003 (Grave; Fuga; Andante; Allegro)
  
• Partita No. 2 in D minor, BWV 1004 (Allemande; Corrente; Sarabanda; Giga; Ciaccona)
  
• Sonata No. 3 in C major, BWV 1005 (Adagio; Fuga [alla breve]; Largo; Allegro assai)
  
• Partita No. 3 in E major, BWV 1006 (Preludio; Loure; Gavotte en rondeau; Menuet I; Menuet II; Bourée; Giga)

W    hen I have presented this cycle before, I have found audiences very moved by the enormous architecture and profound emotional content of it—all drawn from the tiny ‘box’ of one violin.”
  — Nicholas Kitchen, program notes, Park University, 19-FEB-2009.

• Nicholas Kitchen website
  
• MusicKitchen.org music creativity website
  
• Nicholas Kitchen bio at Borromeo Quartet website
  
• Butt J, ed. The Cambridge Companion to Bach. Cambridge Univ, 1997.
  
• Butt J. Bach Interpretation: Articulation Marks in Primary Sources of J. S. Bach. Cambridge Univ, 1990.
  
• Geck M. Johann Sebastian Bach: Life and Work. Harcourt, 2006.
  
• Geiringer K. Johann Sebastian Bach: The Culmination of An Era. Oxford, 1966.
  
• Gerrard L. Whale Rider. (4AD, 2003.)
  
• Mendel A, Wolff C, David H, eds. The New Bach Reader: A Life of Johann Sebastian Bach in Letters and Documents. Norton, 1999.
  
• Wolff C. Johann Sebastian Bach: The Learned Musician. Norton, 2001.
  
• Sonatas and partitas for solo violin, page at Wikipedia
  
• DSM. Assistive technologies—AirTurn®, Tablet PCs, MusicReader®. CMT blog, 09-DEC-2008.

T    his is the very womb and bed of Enormity.”
  —  Ben Jonson, ‘Bartholomew Fair’, 1614.

Assistive Technologies for Musicians with Low Vision and/or Tremor: AirTurn, Tablet PCs, MusicReader

I    am a pianist and about six months ago I was diagnosed with Age-related Macular Degeneration (AMD)—in both eyes. Actually, the two eyes are pretty different in how big the blind spot is. My right eye has a blurred area that makes music staves bend and notes blurry when I try to look directly at them. Dots disappear or blur into adjacent note-heads, 32nd beams look the same as 16th beams, and so on. The left eye is much worse, so what I see in the field that is affected relies almost entirely on what I’m seeing through my right eye. In spite of this, I can see almost well enough to read the page of music, so long as I am not looking directly at it—in other words, so the measures are off to the side of my ‘blind spot’. In the periphery, my vision is still pretty good. This adaptation—using my non-central visual fields for detailed seeing (I call them ‘non-central’; it seems wrong to call them ‘peripheral’, since it’s only a few degrees away from the central blind spot.) Also I find it works better for me to play on my MIDI keyboard with the chair raised higher, so I am looking down at the music instead of looking a bit upward, above eye-level, which is where the music is on my piano. It’s a far-from-ideal posture from a performance point of view. But looking downward at the music seems—for me, at least—to enable me to use parts of my field of vision that are less affected than other areas, which is a trade-off I’m happy to make.”
  —  Anonymous email to CMT.

Thank you, to the several people who emailed me about the CMT post about Pianoteq as a prosthetic ‘aid’, to enable people whose physical impairments would otherwise limit what they can do at the keyboard, to continue to perform on keyboard in the satisfying ‘manner to which they were accustomed’. Thank you, too, to the emailer above, for asking about visual impairments. There have been several other CMT readers who have had similar questions over the past several months, so now is as good a time as any to respond.

Y ou should know that you are not alone in your search for solutions to your visual acuity problems and your efforts to continue playing. According to current U.S. statistics, about 7% of all pianists between age 40 and 100 have AMD. Pianists who have (had) AMD include:

• Arthur Rubinstein (1887-1982)
  
• Helen Kolozsvary (1922-2007)
  
• J. Wayne Streilein (1935–2004)
  
• Madeleine Titus (1914-2008)
  
• Earl Wild (1915-)
  
• Jennie Lois Windle (1915-)
  
• Sylvia Zaremba (1931-2005)

Age-related macular degeneration is the leading cause of blindness and visual impairment in the developed world. ‘Blindness’ as defined by the U.S. definition is a best-corrected visual acuity of 20/200 or worse (20/200 in the better-seeing eye, where the acuity of left eye and right eye are substantially different). ‘Low vision’ is defined as a best-corrected visual acuity worse than 20/40 but better than 20/200 (in the better-seeing eye, if left and right are different).

AMD is the leading cause of blindness in Americans 50 and older, and its prevalence in the U.S. is expected to increase to 18 million by 2020. There are similar epidemiologic statistics in Europe and elsewhere.

M acular degeneration is a disease of the eye causing the light-sensing cells of the macula to malfunction resulting in partial or complete blindness. The macula is the central portion of the retina directly opposite the lens. The retina is the portion of the eye responsible for receiving light and sending electrical impulses to the brain that precipitates with sight. Specifically, the macula is responsible for the sharp, straight-ahead vision used in seeing fine detail, reading printed material, driving, watching television, reading things at normal magnification on computer screens, and recognizing faces.

Loss of vision with age-related macular degeneration (AMD) normally occurs gradually and will usually affect both eyes, although not necessarily at the same rate or to the same extent in each eye. Macular degeneration is most often found in people over 60 years of age, although there are some hereditary forms of macular degeneration that affect children.

• Gradual decline of central vision which tends to progress at different rates in the two eyes
  
• Difficulty reading or performing tasks that require the ability to see detail
  
• Straight lines appear distorted
  
• Center of vision appears distorted compared to the rest of the scene.
  
• A dark, blurry area or "white out" appears in the center of vision
  
• Color perception changes or diminishes.

Y ou can test yourself with the Amsler Grid below. If you need reading glasses, put them on while you look at the Amsler Grid. The grid should be at about the same distance from your eyes that any other reading material would be. Cover one eye, then focus on the dot in the center.

• Do any of the lines look wavy, blurred or distorted? (All lines should be straight, all intersections should form right angles and all the squares should be the same size.)
  
• Are there any "missing" areas where you can't see the grid lines?
  
• Are there any "dim" areas in the grid?
  
• Are you unable see all corners and sides of the grid when you are focusing on the dot in the center?

Repeat the procedure with the other eye covered.

If you answered ‘Yes’ to any of the four questions above for either eye, make an appointment with your eye doctor right away. You can print the page, mark the areas of the chart/grid that you’re not seeing properly, and bring your marked-up grid with you to your eye exam.

If you’ve recently been diagnosed with AMD, there are many good books and online resources that you and your family members can take advantage of. Some of them are in the list at the bottom of this post. Laser treatments and other standard therapy alternatives are covered in those resources, and I won’t go into those here. But there are some newer things that I’ll at least mention, with some links at the bottom to enable you to explore on your own.

Over the past several years, people who have severe AMD have received off-label treatment with Avastin™ (bevacizumab), an anti-VEGF drug made by Genentech that was the first anti-angiogenic therapy approved for treating colorectal cancer. Ophthalmologists reasoned that if Avastin could block blood vessel growth in tumors, it might also affect angiogenesis in “wet” AMD. Genentech’s Lucentis™ (ranibizumab) was recently FDA-approved specifically for the treatment of “wet” AMD, and it is similar in molecular structure and action to Avastin. In a large, two-year study, this drug stopped vision loss in more than 90 percent of patients studied and restored vision in 33 percent. Scientists are now comparing the efficacy of Lucentis and Avastin, since Avastin is much less expensive than Lucentis.

The recently introduced anti-vascular endothelial growth factor (VEGF) intravitreal injections of Genentech’s ranibizumab (Lucentis™) and bevacizumab (Avastin™) generated a heated research argument: on the one hand Lucentis was proven effective and relatively safe in large prospective double-blinded studies, albeit this drug is expensive and might cost up to $1,000 per injection into the eye. Eyetech Inc’s pegaptinib (Macugen™) has the same anti-VEGF mechanism of action and is also quite expensive. On the other hand, Avastin is widely used worldwide as a low cost alternative for Lucentis, with an estimated cost of about $120 per injection, although its effectiveness and side effects were previously investigated only in smaller retrospective studies and only recently have been studied in larger prospective ones.

But those medications are used mostly in AMD that is already severe/advanced. They generally are not (currently) used in a pre-emptive or preventive fashion, or in early or mild cases of AMD. This may be in the process of changing, insofar as these medications—in clinical trials and in off-label observational studies—are evidently able to stop the progression of the disease, for two years or longer. How much longer is not known, since the clinical trials have not followed the patients for much longer than that yet.

L    ooking to the right slightly seems to be better than putting the music in the center or putting it where I have to look a little off toward the left. I can’t imagine why this is, except maybe it has something to do with what parts of each eye are damaged by the AMD. My adjustments almost make it possible to play pieces that are very familiar to me. But I don’t know how much longer this trick will be adequate. I can imagine a couple of years from now the AMD might be worse and these little tricks won’t be enough anymore, and I’ll have to stop playing. Even now, it’s next to impossible for me to get a new piece and try to learn it. My sketchy non-central vision is good enough to remind me of what my fingers and mind already learned years ago, but it’s not good enough to enable me to learn an entirely new piece. But it seems to me that if I could just magnify things a bit—like I do on my PC when I’m reading an Acrobat document or something—then I would be able to manage. Increasing the size of the music would enable me to make-do with what I’ve got and the non-central vision would be enough if only the music were way bigger. Increasing the wattage of the music lamp doesn’t seem to help; just makes the glare worse. Does this make sense? Is there something different I should by trying? I saw the things you wrote about ‘assistive’ uses of Pianoteq for pianists with disabilities, and I thought you might have suggestions about pianists with AMD.”
  —  Anonymous email to CMT (continued).

Interestingly and in regard to the remark in the email above about ‘non-central’ visual fields mitigating the deficits in the foveal/central field, earlier this year Lingnau and colleagues at the Technical University of Braunschweig studied training people to use a parafoveal retinal location for reading. The study was designed to find out which part of the visual field is best suited to take over functions of the fovea during early stages of macular degeneration. A region to the right of the area you are needing to read leads to best (most accurate; quickest) reading performance and the most natural gaze behavior (so that the eyes do not get tired right away).

By contrast, reading performance was severely impaired when Lingnau and the other researchers asked the subjects to use a region to the left or below the area of visual fixation. An analysis of the underlying eye-muscle behavior revealed that ‘practice effects’ were accompanied by a larger number of ‘saccade’ eye movements in the text direction and decreased the visual fixation durations. Their journal article explained the observed performance differences at different retinal locations in terms of the neurophysiology of the interplay of attention and eye movements. The research has important implications for the development of training methods for AMD patients who aim to retain the ability to read detailed material such as sheetmusic. Most specifically, the research suggests that it is beneficial for AMD patients to use a region to the right of their central blind-spot, much as the CMT emailer has independently discovered.

W hat other non-medical, non-pharmacological things can a musician with AMD do, to compensate for the visual deficit?

• Increase the contrast between light and dark objects;
  
• Reduce glare with proper lighting (halogen bulbs are better than low-energy fluorescent, which in turn are better than incandescent);
  
• Use curtains or shades to reduce ambient glare from light-sources near your piano;
  
• Play for short periods, taking breaks that do not involve other visually-intense activity before returning to the keyboard;
  
• Follow the nutrition (with vitamin supplements recommended in books and professional society / AMD support group websites; see links below) and lifestyle recommendations of ophthalmologists and other experts;
  
• Replace your music with nice, high-contrast magnified sheet music—either photocopy and enlarge it yourself, or use a PC-based means to display digital sheet music (usually as Acrobat pdf files, either purchased or obtained free online or scanned using an inexpensive scanner-printer-fax attached to your PC).

M agnifying the music, either in hardcopy by enlarging it in a copier or by doing it digitally on your computer? As shown by Chung and colleagues in Houston, there is no need to increase the spacing between staves, to normalize reading speed in AMD patients. You just need to make the staves and notes and markings bigger; the space between the staves can be the same as in a normal score. Of course, if you’re making hardcopy 200%-size photocopies and cutting-and-pasting them to create a score that will fit on your music stand, you might go to the trouble of doing the paste-up staff-by-staff. But most of us would just scan the music as pdf Acrobat files, and then the spacing between the staves will be magnified by the same percentage as the staves themselves. That means that there’s more ‘white-space’ to scroll through, to reveal the next group of staves further down the page. That’s maybe a small thing to complain about if the alternative is not being able to see/play at all. But it is a significant annoyance, as I’ve found with my own use of a tablet PC for displaying my own music. Here is a little table that shows the amount of magnification you would need, depending on what visual acuity you have with your glasses or contact lenses on. In other words, the left-hand column is the ‘best-corrected’ acuity you have, not your visual acuity without corrective lenses.


The thing that I like best about playing from digitized music on a tablet PC (or, for a bit more money, the MuseBook) is that you can set and adjust the magnification exactly how best suits you and the particular score you are reading. You can adjust the display contrast to be extra bright and contrasty if you want. You can tweak the RGB color controls on the monitor, to compensate for any color issues that your AMD is causing. You can’t do any of those things with hardcopy paper music.


By far the most extensive source of information on tablet PC-based music and practical technology and techniques to use it is on pianist Hugh Sung’s website and blog. His site has many practical tips and video demonstrations that explain how to do various things.


Please also consider getting an electronic pedal page-turning device for your PC. The AirTurn™ device is one that I recently bought. I find that it is very well built—sturdier than other options that are available. I like the Boss FS-6 dual pedal version of AirTurn™ a lot. The FS-6 pedal has a nice ‘feel’ and the pedals are spaced at a distance that makes it convenient to click pages forward and backward without risking a mistake and advancing too far. Other pedals that I have tried over the past ten years are either too dainty or too industrial/stiff and take your concentration away from your playing; this FS-6 pedal is non-intrusive and easy to get used to. Here is a photo of Hugh Sung at Curtis Institute, holding one of the Boss FS-6 pedals...


The AirTurn™ AT-104 is an RF device, so there are no wires snaking up from the pedal up to the piano. Attached to the pedal you have a little battery-powered transceiver that sits on the floor. (Mostly, its power consumption from the battery occurs when the device is transmitting pedal events to the PC, so the battery lasts quite a long time, even with active pedaling and prolonged use.) And the other part of the transceiver ‘pair’ is a tiny dongle that plugs into a USB port on your computer, much like dongle you use with an RF mouse. It receives the signals from its mate on the floor, enabling the software in your PC to scroll or jump down the page or page-forward or -backward. The AirTurn™ system has 65,000 RF pairing IDs available; you select an unused ID so the AirTurn™ will not interfere with your RF wireless mouse or other 2.4GHz RF computer accessories you have.


The ability to mark-up and save annotated copies of your sheet music—save them as different filenames so your original music remains ‘clean’—is a great advantage. And you can keep changing your annotations—no erasing! Very nice.


I am using my AirTurn™ with MusicReader™ software with my 1920x1200 and 1680x1050 monitors oriented in ‘landscape’ mode, and that works fine with my big “piano reading glasses” and even my bifocals. But MusicReader can be used with iRotate™ or other software to rotate the display to a vertical ‘portrait’ format instead of the default ‘landscape’ horizontal format.

I’m hoping at some point to try a dual-display monitor. Those are extensively used in financial trading—including people who do day-trading of stocks and commodities (or options and futures) at home—and by some gamers. The prices of dual-display monitors and the associated screen-splitting software have come down quite a lot over the past several years, due to their popularity. For music reading with diabetic retinopathy or other conditions that do not primarily involve a central macular deficit, maybe dual portrait-oriented displays—like the Zenview DuoPortrait 20 Pro pictured below—would be an advantage. But for other CMT readers—and maybe especially ones with early- to intermediate AMD where you are relying on ‘non-central’ visual fields—two landscape-oriented monitors may be better. In either instance, you will probably have to work out a different type of ‘stand’ for the monitors, because the ones that come with them from the factory (a) will not sit nicely on your Steinway and (b) will vertically position the centers of the monitors too high in your visual field. You will need either to go without a stand (monitors sitting on the piano in their bezel but without a stand) or find something that is squattier than the desktop-style stand that these products come with.


Note that the digitized sheetmusic is moved forward or backward by each pedal press; it doesn’t ‘jump’ across many pages to follow D.C. or al segno or other ‘marks’. In such cases you may want to make your own pdf (using a ‘full’ Acrobat license, not just AcrobatReader) that replicates each section that is to be repeated, and assemble the replica page/pages sequentially, so that instead of doing multiple pedal presses to jump backward you are doing a single pedal press to go forward into the repeat, or a single pedal press to skip forward over a section to the segno.

These products are not just for musicians with visual impairments. I do think that AirTurn™ and related products will significantly help older pianists who have ‘essential tremor’ or arthritis or other conditions that make reaching and turning music pages difficult. To quickly and easily and reliably navigate your digitized music by pressing pedal footswitches is a joy, compared to struggling and often failing to turn the paper pages accurately and with confidence.

One last thing. I put together a little spreadsheet that shows the AREDS scoring method that ophthalmologists use to assess the severity of your AMD and estimate prognosis for disease progression on a 5-year timescale. If you wish, you can click on the screenshot below and download the Excel file and play with it. Discuss with your ophthalmologist the specific findings and changes that she/he observes in your eyes and ask about what changes you might expect over the next 5 years based on the AREDS studies. Overly-quick office exams are not what you want. You want to go to the eye doctor prepared with questions to ask, so you can get specific answers and good prognostic advice.


Please have a look at the links below. Email me with comments, questions, or suggestions you may have. If there is enough interest, I will compile them into future CMT posts on ‘assistive technologies’ for musicians. Thank you!

• Hugh Sung website
  
• AirTurn Inc. website
  
• Resources page at AirTurn Inc. (tablet laptops, scanners, music reading software, suppliers of sheet music)
  
• Hugh Sung page at Curtis Institute of Music
  
• National Eye Institute (U.S. NIH)
  
• NEI statistical data, prevalence of blindness by age-group
  
• AMD.org
  
• Foundation Fighting Blindness
  
• Macular Degeneration Support
  
• Macular Disease Society
  
• American Foundation for the Blind
  
• AHAF.org
  
• Schepens Eye Research Institute (Harvard Univ)
  
• Age-Related Eye Disease Study Research Group (AREDS). A simplified severity scale for age-related macular degeneration. Arch Ophthalmol. 2005; 123: 1570-4.
  
• Ip M, Scott I, Brown G, et al. Anti-vascular endothelial growth factor pharmacotherapy for age-related macular degeneration. Ophthalmol 2008; 115:1837-46.
  
• Jonas J, Ihloff A, Harder B, et al. Intravitreal bevacizumab versus triamcinolone acetonide for exudative age-related macular degeneration. Ophthal Res 2008; 41:21-7.
  
• Jun J, Kim Y, Kim KResolution of severe macular edema in adult coats' disease with intravitreal triamcinolone and bevacizumab injection. Kor J Ophth 2008; 22:190-3.
  
• Kadrmas E, Dyer J, Bartley G. Visual problems of the aging musician. Surv Ophthalmol 1996 40:338-41.
  
• Kook D, Wolf A, Kreutzer T, et al. Long-term effect of intravitreal bevacizumab in patients with chronic diffuse diabetic macular edema. Retina 2008; 28: 1053-60.
  
• Krebs I, Lie S, Stolba U, Zeiler F, Felke S, Binder S. Efficacy of intravitreal bevacizumab therapy for early and advanced neovascular age-related macular degeneration. Acta Ophthalmol 2008 Oct.
  
• Lim J, ed. Age-Related Macular Degeneration. 2e. Informa, 2007.
  
• Lingnau Q, Schwarzbach J, Vorberg D. Adaptive strategies for reading with a forced retinal location. J Vis 2008; 8: 6.1-18
  
• Lyons K, Pahwa R, eds. Handbook of Essential Tremor and Other Tremor Disorders. Informa, 2005.
  
• Mayo Clinic. On Vision and Eye Health: Practical Answers on Glaucoma, Cataracts, Macular Degeneration & Other Conditions. Mayo, 2002.
  
• Merciera E. Non-Age Related Macular Degeneration. Nova, 2008.
  
• Mogk L, Mogk M. Macular Degeneration: The Complete Guide to Saving and Maximizing Your Sight. 2e. Ballantine, 2003.
  
• Paul E. Conquering Macular Degeneration: The Latest Breakthroughs and Treatments. Trafford, 2006.
  
• Plumb M, Bain P. Essential Tremor. Oxford Univ, 2006.
  
• Roberts D. The First Year: Age-Related Macular Degeneration: An Essential Guide for the Newly Diagnosed. Da Capo, 2006.
  
• Samuel M. Macular Degeneration: A Complete Guide for Patients and Their Families. Basic Health, 2008.
  
• Schouten J, la Heij E, Webers C, Lundqvist I, Hendrikse F. A systematic review on the effect of bevacizumab in exudative age-related macular degeneration. Graefes Arch Clin Exp Ophth 2009; 247:1-11.
  
• MusicReader B.V. website (The Netherlands)
  
• iRotate software
  
• PDFannotator software
  
• Zenview Duoportrait 20 Pro (total diagonal size: 34.4 inch (32.2 inch W x 12.1 inch H); total screen resolution: 2400 x 1600 pixels; Pixel pitch: 0.26mm; aspect ratio: 4:3x2)
  
• Zenview Manager multi-screen software
  
• NVIDIA GeForce graphics cards supporting dual monitors with display resolutions up to 2560 x 1600 pixels at up to 85 Hz
  
• NVIDIA nView multi-display software
  
• MagniSight.com
  
• SmartView (Humanware)
  
• IRTI digital magnifiers
  
• ClearView (Optelec)
  
• Merlin (Visiontech)
  
• Lucentis.com
  
• Avastin.com
  
• Macugen.com
  
• VisiVite (vitamin A 25KU, vitamin E 400 U, vitamin C 500 mg, Zinc 80 mg)
  
• DSM. Better Eyeglasses for Chamber Musicians? CMT blog, 16-NOV-2007.
  
• DSM. Assistive Technologies 2: ‘Disability Arts’ and Special User Interfaces. CMT blog, 28-MAY-2008.