jwilzewske: performance

Showing posts with label performance. Show all posts

Monday, January 16, 2012

How likely to sing after radiation therapy for head-and-neck cancer?

F or oropharynx and nasopharynx cancers, it is sometimes possible to limit the dose received by the larynx according to the extent of the primary lesion. Thus, if the tumour constraints permit, the maximum dose to the larynx must be less than 63 to 66 Gy. To reduce the risk of laryngeal edema, it is recommended if possible to limit the mean non-involved larynx dose to 40 to 45 Gy [to prevent dysphonia or significant damage to vocal cords/folds].”
— C. Debelleix and co-workers, Centre Hospitalier Dax-Côte d'Argent, France.

T he question in this post's title has arisen several times each year over the 5 years I've been writing this blog. A relatively small percentage of the approximately 52,000 persons per year who receive a diagnosis of some form of cancer of the head and neck (U.S. SEER statistics; AHRQ HCUPnet statistics for procedures HCPCS L30318, G0251, G0339, G0340; CPT-4 77373, 77401-77435, etc.; ICD-9 92.3x) and the thousands of patients (U.S.) who receive radiation to the neck as part of a treatment regimen for a head-and-neck cancer are singers—either avid amateurs or professionals. However, the rate of inquiry by (or on behalf of) singers for whom this situation does happen is evidently not by any means ‘rare’. There have been 6 such search-strings that I have noticed in the CMT traffic logs in the past 3 weeks alone.

S o this post is meant to provide you with links to recent medical literature that you can show to your otolaryngologist/oncologist and discuss. In that regard, the typical radiation oncologist tends not to be expert in medical management of musicians; conversely, specialists in medical problems of musicians tend not to have a great deal of experience with head-and-neck cancers for which radiation therapy is routinely used. This is compounded by the fact that the situation of singers undergoing radiation to the neck is just uncommon enough that there are not many clinical trials or specific studies conducted in that population. The published studies that have some relevancy to the question are not easy for your physician to locate online or in the library either—which is why I believe providing these links will be helpful.

A majority of the published work on this topic has to do with ‘quality-of-life’ (QoL) measurement in cancer patients treated with radiation to the neck, where one of the QoL measurements is ease of vocalization and the frequency and severity of pain or hoarseness or other forms of dysphonia or vocal abnormalities.

F or each patient, the specific cancer type and the extent of the cancer’s spread and other factors contribute to the decision-making as to whether ‘larynx-sparing’ reduced-dose, stereotactic, imagery-guided radiation therapy is a sensible approach or not. But in those cases where it is deemed to be a reasonable approach, there are specific guidelines for planning and conducting such radiotherapy.

O f course, there is no guarantee that returning to singing will be achievable, or that vocal quality or agility or range or endurance will be the same as they were prior to treatment. But to get the best chance for those outcomes, the info in the lit below should be part of your decision-making with your doctors.

I f you’re one of those who’ve been hitting the web and this blog looking for info on larynx-preserving radiotherapy and prognosis with regard to return to post-treatment singing, maybe the links below will be useful for you and your doc!

Tuesday, January 3, 2012

Guided imagery in music training and performance

I n order to have fast mobility and clarity on left-hand fingers, string players have to train their fingers to have these 3 elements when dropping their left-hand fingers on the fingerboard: speed; strength; and the fast release right after the drop. The 3 elements on the left-hand fingers take training to build up the strength of the muscles and the speed of the reflex of the fast release. Of course, any ‘tool’ that we gain from our technical training is ultimately to be used to create music that would touch listeners. Sometimes when musicians concentrate too much on technical elements, their music tends to be too mechanical, too careful, and lacks emotion. By contrast, when musicians concentrate on being musical, it actually helps the technical things. For example, whenever I feel my fingers stiffen in fast passages, I always find thinking something light and bubbly helps to increase my fingers’ lightness, mobility, and fast articulations. Whenever I try to sustain a long note [and yet try to musically project vitality and suspense, despite the temporary absence of pitch-change or the lack of overt dynamics changes while the note lasts], I remind myself about the struggles and tension of the music. Whenever I try to create smooth bow changes, I often picture a [calligraphy] paint brush changing its direction, instead of which muscle to move first!” — Jackie Lee, Heartland Music Academy, 2012.

I n reply to the previous post, I received the helpful advice above.

A nother CMT reader emailed me to ask whether there was any scientific research literature that establishes the effectiveness of visual or kinesthetic imagery in music teaching, especially for soloists or chamber performers.

T here’s lots of published research on guided imagery in the neurophysiology and physical medicine and rehab literature—and in the lit for research on aging and stroke. Quite a lot in the dance and sports medicine lit. But there are not very many published controlled research studies in music performance/pedagogy lit, so far as I can tell.

I will continue looking; please feel free to add comment below or email me if there is a reference that you like.

M eanwhile, here are some links to work that’s relevant to this.

T he left arm functions, to a large extent, by 'walking' on the fingers. In actual walking, torso balance shifts forward, and it is caught on top of the moving legs. For the cellist's left arm, a similar balance can be felt when the upper arm shifts and must be caught by another finger or the arm will fall over... This ‘walking’ image can be strengthened by imagining that the fingerboard is a staircase... Picturing this helps you feel that your balance is aligned in the Earth's gravity, even though your fingers look angled-back in relation to the surface of the fingerboard.” — Jeffrey Solow, cellist, quoted in Bruser, p. 121.

I n automatic or cyclical movements, actual and motor imagery (MI) durations are similar. When athletes imagine only the dynamic phases of movement or perform MI just before competing, however, the environmental and time constraints lead to underestimating the actual duration [and the benefits of the guided imagery are diminished, despite the speed and ease with which the imagery for brief or cyclical movements is called up]. Conversely, complex attention-demanding movements take longer to image [and so guided imagery for complex movements has impediments to its effectiveness, even if duration over/underestimation does not occur].” — Aymeric Guillot, 2005.

T he bilateral frontal opercular regions [in the brain] are crucial in both preparation for and during music execution and imagining. They may have ‘mirror neuron’ properties that underlie observation or imagining of one’s own performance. The motor areas are differentially activated during the preparation and execution or imagining the sequence.” — Rumyana Kristeva, 2003.

D uring execution of musical sequences in professional musicians, a higher economy of motor areas [in the brain] frees resources for increased connectivity between the finger sequences and auditory as well as somatosensory loops, which may account for the superior musical performance. Professionals also demonstrated more focused activation patterns during imagined musical performance.” — Martin Lotze, 2003.

Monday, January 2, 2012

How Fast Does Violin Bowstick Go?

S urprisingly, this 2009 CMT blogpost on violin kinematics keeps receiving a lot of pageviews every day, with page visitlengths averaging more than 3 minutes. (I monitor the tags/keywords that cause readers to land on each page, to better understand what topics for future posts might be useful and welcomed. And, for that 2009 post, ‘bowstick velocity’, ‘bow speed’, ‘bowing agility’, and similar phrases are what people seem to be looking for information about.) So I thought I’d gather together here some relevant links on that specific aspect.

A lso, because some people who are searching on these searchstrings and keywords have emailed me to say that they have a desire to increase the maximum velocities that they can propel the bowstick with, I collect some links below that have to do with various athletic activities involving fine motor coordination and speed of the upper extremity. (For pianists, Czerny and Hanon are of course good. For brass players, Arban. For violin family, the Bauer books look interesting, although I have not tried them myself.)

M ost interesting to me are some of the findings in the research papers by Diana Young and her colleagues (jpeg above), showing a tremendous amount of ‘fine-structure’ in the velocity and force timeseries. No matter how ‘smooth’ we think our bowing is, there are a tremendous number of little variations—some of them arising with the interaction of the bowhair with the strings; other of them arising from the ratchety contraction physiology of our muscles.

Thursday, December 15, 2011

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!

Monday, March 14, 2011

Robert Levin: Meta-Mozart and Mozart’s Own Experimentalism/Eclecticism

M olding the ‘clay’, getting your fingers ‘wet’: discovering how Mozart thought, how he might have written things, how he went about doing what he did. This is inevitably humbling—this improvising cadenzas and whole movements that are missing from his works. But it also enables you to more accurately perform and understand the parts that are not missing; to have a better sense that there are [performance] ‘options’ from which to choose.”
— Robert Levin, pianist.

I s it ‘creation’ or is it imitation? Honestly, it is both!

Mozart – Prelude and Fugue in C, K. 394 (4.0 min; 3.5 min)
Mozart – “Adagio variee” K3 Anh. 206a = K6 Anh. A 65 (1.5 min for each of 4)
Mozart – Suite “In the style of Handel”, K. 399 [Sarabande completed by R. Levin] (3.5 min; 3.5 min; 2.2 min; 4.3 min; 3.5 min)
Mozart – Piano Sonata No. 15 in F, K. 533/494 (26.5 min)

W hat you hear in this Adagio, K. Anh. A65, are two parts, A and B, composed by Mozart. And for each of these, I have deconstructed them, stripped them down, and created versions, A’ and B’, removing the decorations… to show what might have been.”
— Robert Levin, pianist.

I n Levin’s improvised material in last evening’s MainlyMozart program in San Diego we get a sense of genuine authenticity in terms of motivic elements, harmonic progressions, modulations, durations that each chord/key prevails until a change is introduced, and so on. Really convincing and wonderful. You don’t necessarily have to have comprehensive (or even ‘adequate’) explanations for the formal structure of Mozart’s music to produce new compositions (or, as Levin is famous for doing, completions of Mozart’s unfinished ones) that have tremendous verisimilitude.

T here is a lot of latitude for interpretation in these pieces—including Levin’s slow, dilated accounts of the first two movements of Sonata in F, K. 533. For example, Schiff, Eschenbach, Uchida, and others turn in Allegro times ranging between 7 min and 9 min, compared to Levin’s 11 min for the Allegro last night. Others’ performances of the Andante range between about 6 min and 10 min, with Levin’s account close to 9 min. And the Rondo Allegretto of this Sonata is, in others’ hands, incredibly varied, ranging from as short as 6 min to 8 min or more; Levin’s tendency toward hyper-masculine emphasis leads him to 6 min 20 seconds with a flourish.

I ’m studying—we all should be studying, like students learning a new language. People study French, German, Italian, Chinese… eventually they become fluent speakers, if they work hard at it. Well, why not think of Mozart as a language, one that must be learned, in a conversational way? I am studying Mozart! I’m just trying to improve my diction—trying to get my ‘accent’ better.”
— Robert Levin, pianist.

L evin’s remarks remind me of David Cope, composer and professor at UC Santa Cruz, who 20+ years ago created Emmy, a LISP-based software application that produced scores in the style of classical composers. Some time ago Cope decided to sunset Emmy. It has been superceded by a new package, called Emily Howell, another in his suite of computer models of musical creativity.

L iterary theorist Frederic Jameson considers the ‘effacement’ of a personal style and its replacement by ‘pastiche’—not parody as in Bruce Adolphe’s comedic and educational routines but the borrowing and recoding of historical idioms, adopting jargon popularized by others, and repurposing ornaments and decorations that previously held different meanings—as fundamental elements of post-modernism. It is a “celebration of surfaces, which denies the hermeneutics of depth” (Jameson, pp. 64-5.) It’s like speech in a dead language, but speech that is devoid of parody’s ulterior, satiric motives. [Satie and Debussy co-opted and experimented with other styles and did pastiches. Nyman’s book covers some of this history of ‘experimental’ music.]

L evin marveled aloud about the brevity of the fragments that were his starting-materials… conjured the notion of Mozart as a dilettante... abandoning a Gigue in 5 bars; the Sarabande that Levin completed, abandoned by Mozart in 4 bars, just the merest sketch now extant; Mozart becoming very quickly disinterested in the art of fugue, having been goaded into attempting it by his wife.

B ut these idiosyncrasies and peccadillos of Mozart’s become in Levin’s hands a wonderful asset—they serve as a pretext for better understanding the man and the music, or, as many have noted, reviving the art of improvisation and honoring ‘freshness’ and novelty in classical music performance.

W hat has happened in the last generation or so is that objects—musical scores—have become ‘sacred’. People focus far too much on adhering literally to the notes that are written on the page. It is far better, I believe, to have a sense of responsibility to create something new in performing each work—it needs always to be ‘dangerous’.”
— Robert Levin, pianist.

R obert Levin studied piano with Louis Martin in New York City, and composition there with Stefan Wolpe. He was invited to study with Nadia Boulanger at the American Conservatory in Fontainebleau, France, and in Paris while still a teenager. He studied composition with Leon Kirchner, and piano with Clifford Curzon, Robert and Jean Casadesus, and Alice Gaultier-Léon. He was appointed head of music theory at the Curtis Institute in 1968, on the recommendation of Rudolf Serkin. Levin’s highly praised Mozart fortepiano concerto series, with Christopher Hogwood and The Academy of Ancient Music, was released in 1994 on the L’oiseau-Lyre label. Levin has been commended especially for his improvised cadenzas, a once-popular performance practice that some have credited him with restoring to tradition. His version of Mozart’s Requiem was premiered in 1991 in Stuttgart at the European Music Festival, conducted by Helmuth Rilling. Since 1993, Levin has been a professor at Harvard, where he serves as a Dwight P. Robinson Jr. Professor of Music Performance & Analysis and Professor of the Humanities.

Tuesday, February 1, 2011

Musicians’ Focal Dystonia Update 2011

L osses incurred in the wounding and in the healing both serve as ‘seeds’ for growth. We cannot wish away the loss, so it is well if we accept the seeds and nurture them, and see what fruit they bear.”

T here have been several dozen readers (TCP/IP addresses in U.S., Canada, U.K., Greece, Italy, Germany) who have landed on this blog in the past 2 weeks by searching Google with “focal dystonia” and related phrases. Some of them used the phrase ‘personalized medicine’ or ‘genomics testing’ as part of their Google search. In response, I want to provide some new resources, beyond ones in my previous focal dystonia-related posts in past years (links below). It is not my intent that all of the resources will be relevant to everybody who reads this post, only that some of the materials will be useful to some of the readers.

W hile I do not have dystonia myself, I know a couple of musicians who do have it. They developed it after years of intensive performance and work at leading conservatories, after achieving mastery of their respective instruments and after having embarked on promising concert careers. For each of these friends, the condition was career-changing. Both are now teaching, primarily; the shift in their attention is source of much joy and satisfaction, surely, and a fantastic treasure in terms of effective, practical pedagogy imparted to the next generation. But it comes at tremendous cost, in terms of foregone income and beauty—performances and recordings prevented, in careers hobbled by focal dystonia.

M y interest in keeping track of current state-of-the-art with regard to diagnosing and treating focal dystonia is in direct proportion to the distress and disappointment I have witnessed in these friends. Besides the recent spate of anonymous searches and CMT page-views, the emails I receive from CMT readers confirm that this condition frequently goes unrecognized or un-diagnosed for years, depending on whether there are dystonia-experienced clinicians accessible to you, ones who specialize in caring for musicians or other performing artists. In other words, if a doctor has never ever seen a case of dystonia before, the probability that he/she will diagnose one now is disproportionately low. This problem is compounded by the fact that focal dystonia does not have obvious signs and symptoms when seen in the clinic.

W ith the intensifying interest in relatively inexpensive direct-to-consumer (DTC) genomic testing from deCODE and 23andme and other companies and with recent years’ trend toward consumers’ taking progressively greater responsibility for diagnosing and managing their own health conditions, I gather together links below, links to the most recent research literature that bears on genetics and genomic polymorphisms that might enable musicians to look at their DTC genomics tests’ raw file download results and bring that evidence with them when they meet with their physicians. Given that the spectrum of focal dystonia is quite broad and pleomorphic, maybe this will help musicians to take charge of the situation, especially if the doctors seem too inclined to ‘wait and see’ or discount the severity of what the patient in front of them is complaining of. Even if the physician has no prior experience with genomics tests per se, it is hard for the physician to be dismissive when the patient in front of him/her is knowledgeable and comes bearing specific evidence with the expectation the evidence will be discussed.

I n this regard, if one of my friends who has focal dystonia discovered that he does have one of the dystonia-associated genomic polymorphisms, then that discovery might be helpful to him and his wife with regard to preventing dystonia in their kids, insofar as the intensity and duration of musical-instrument practice are strongly correlated with triggering the onset of dystonia. One can be a genetic carrier of the genetic variation but remain asymptomatic so long as one doesn’t hit the trigger-point in terms of over-use or over-training. If you are a parent, such information would surely modulate how you approach the musical education of your children...

A t present, researchers have recognized multiple forms of dystonia that have strong association with genetic variations. They have so far identified multiple genes and chromosomal locations responsible for various forms of dystonia. Most of these are rarer and more severe forms than the focal variety that is seen in musicians. But the same genes—and some of the same variations/mutations—have been found to be involved in cases of musicians’ dystonia.

DYT1 (TOR1A) – Early onset-primary dystonia
DYT2 () – Autosomal recessive primary dystonia
DYT3 (TAF1) – X-linked dystonia
DYT4 () – Non-DYT1 spasmodic ‘whispering dysphonia’ [singing]
DYT5 (GCH1) – Dopa-responsive dystonia
DYT6 (THAP1) – Adolescent-onset mixed-type dystonia
DYT7 () – Adult-onset primary dystonia
DYT8 (MR1) – Paroxysmal non-kinesigenic dyskinesia
DYT9 () – Paroxysmal choreoathetosis with dystonic spasticity
DYT10 () – Paroxysmal kinesigenic dyskinesia
DYT11 (SGCE) – Myoclonus dystonia
DYT12 (ATP1A3) – Rapid-onset dystonia-Parkinsonism (RDP)
DYT13 () – Early- and late-onset focal dystonia
DYT15 () - Alcohol-responsive myoclonic dystonia
DYT16 (PRKRA) - Dystonia-Parkinsonism
DYT17 () - Segmental or generalized dystonia with dysphonia [singing]
DYT18 (SLC2A1)
DYT19 () - Episodic kinesigenic dyskinesia 2
DYT20 () - Paroxysmal non-kinesigenic dyskinesia 2

T o the reader who recently emailed me, the Phe205Ile (613T>A; see Calakos 2010, link below) polymorphism in the TOR1A gene on Chr. 9 is associated with jaw/embouchure dystonia in the cases that have been studied to-date, although there may be other genes and polymorphisms associated with that condition/phenotype, too. Unfortunately, this particular SNP polymorphism is not included at this time in the microarray chips that 23andme and deCODEme use for their DTC genomics testing, and it is not available in other presently-available tests either so far as I can tell. There are, however, 7 TOR1A SNPs and 4 TOR1B SNPs that are tested, 16 SNPs in the GCH1 gene, 9 SNPs in SGCE, 2 SNPs in ATP1A3, 6 in MR1, 2 in PRKRA, 2 in TAF1, and so on. These are there in your 23andme raw file download results, ready for you to look at and see whether you do or don’t have a variant polymorphism at one or more of these SNP locations.

A t any rate, there seems to be a pent-up demand for resources, links, referrals, anything at all—an unmet need for new information or updates, year-to-year—plus a considerable amount of new information that has accumulated since I last put up a blog post on this topic. Which is why I gather these things and put them up online right now.

M usicians’ dystonia is a task-specific movement disorder that produces cramping and loss of voluntary motor control of muscles that are involved in highly-trained movements associated with performing music. About 1% of all professional musicians develop musicians’ dystonia, although the percentage may be considerably higher since there are many whose condition is never definitively diagnosed and many whose change of career never comes to the attention of researchers who write the journal articles reporting the nominal 1% prevalence figure.

T he pathophysiology of the disorder is not completely clarified. Findings in neurophysiology testing include reduced inhibitory signals at different levels in the brain, abnormal neuroplasticity, and altered sensory perception. Epidemiologically, there is higher risk for those musicians who play instruments requiring maximal fine-motor skills, such as piano, but the condition also occurs in brass players, double-reed players, and singers. For instruments where workload differs across hands, focal dystonia appears more often in the more intensely-used hand—the right hand in guitarists and lutenists. Preliminary findings also suggest a genetic contribution to focal task-specific dystonia with phenotypic variations including musicians’ dystonia. Treatment options include pharmacological interventions, such as trihexyphenidyl or botulinum toxin-A, as well as retraining programs and ergonomic changes in the instrument. Only a minority of musicians, however, return to fully-normal motor control using the currently available therapies. The non-optimality of current therapies—combined with the expectation that identifying the genes, genetic variations, and receptors that are involved in the condition may lead to new, more-effective therapies targeting those receptors in the nervous system—are what drives the recent genomics-based research in this area.

A t the Glasgow Royal Infirmary’s Department of Physiotherapy, eight musicians recently volunteered to take part in a retraining protocol and were studied by Patrice Berque and collaborators. Intensive ‘constraint-induced therapy’ and motor control retraining at slow speed were the interventions Berque examined. They made video recordings of the subjects playing. They measured ‘Frequency of Abnormal Movements’ scale (FAM), the change in metronome speed achieved during motor control retraining, plus two other dystonia evaluation scales. Over a 12-month period, the FAM scale scores showed statistically and clinically significant decrease in the number of abnormal movements per second of instrumental playing. Statistically, significant changes did not appear until about 8 months of therapy. Berque’s results suggest that a combination of constraint-induced therapy and specific motor control retraining may be a successful strategy for the treatment of musicians’ focal dystonia, and suggest that many months may elapse before significant progress occurs.

I n Cheng’s series, three people were found to have the delGAG deletion in the TOR1A (DYT1) gene, and two patients were found to have polymorphisms in the THAP1 gene (224A>T, 449A>C). The overall mutation frequency was 4.5% in Cheng’s patients, with TOR1A mutations found in 2.7% and THAP1 mutations found in 1.8%. No mutations were detected in the control population of normal Chinese. The significance with respect to musicians’ dystonia is not addressed by Cheng, but, by implication, we may anticipate that the genomic epidemiology of musicians’ dystonia may be subject to racial/ethnic variations in much the same manner as the genomic epidemiology of other forms of dystonia varies by race and ethnic ancestry.

Wednesday, January 19, 2011

The Importance of [a modest number of—] ‘Wrong’ Notes

Authenticity is not the only quality for which a performance might be valued. Where a relatively inauthentic performance is highly valued, it is valued in spite of its ‘inauthenticity.’ For example, Schnabel’s recorded performances of the Beethoven sonatas are well regarded despite the wrong notes that they contain.”
— Stephen Davies, p. 47.

Beethoven marks ‘fugue in 3 voices with some license’, which is a serious understatement [Sonata No. 29 in B-flat Major, Op. 106, “Hammerklavier”] and which I read as something of a joke: the joy of the joke being the extent to which Beethoven will simply flaunt the very idea of a fugue. Though the fugue subject begins with a series of consonant, descending thirds (taking up an obsessive theme of the piece as a whole), pretty soon its running sixteenth notes have a willful tendency to encounter all sorts of dissonant neighbors, and these ‘wrong notes’ become a subject for the composer’s perverse and inventive discourse. Beethoven’s ‘play’: causing all kinds of collisions of one dissonant neighbor with another and then miraculously making sense of them: this is the playful creation and resolution of chaos.”
— Jeremy Denk.

I was recently checking to see how my friend, pianist Victor Goldberg, is doing with his Asian tour. As part of my online “checking up,” I looked at his Twitter feed, which I had not done in awhile. There was not much in the way of updates about his performances in Hong Kong or Taiwan or Thailand in there, but there was this little tweet from last June, which I’d not previously seen.

Are wrong notes that important?”
— Victor Goldberg, Twitter, 23-JUN-2010.

N umber one, Victor plays exceedingly well, with wonderful expression and technique. He does not produce wrong notes—at least not many of them, and especially not many of them in the context of the difficult, finger-challenging repertoire he performs. His tone remains consistently focused, clear, and centered throughout the range. The pulse remains secure, and his rhythms are accurate for the style. Dynamic levels are consistent, emotionally coherent, and an accurate interpretation of the style. Phrasing remains always consistent and sensitive to the style. Expressiveness manifests creative nuance and style, remaining responsive not only to the score but to other performers and the audience. Articulation has secure attacks, and all markings (staccato, legato, slur, accents, etc.) are executed accurately. In short, anyone who has heard Victor play would be astonished by his Tweet from last June.

N umber two, Victor’s recoveries from any notes he misses are invariably graceful and, if anything, the few misses lend in an admirable way to the overall humanity of his performances. We do not attend to hear damned automatons or computers perform. We come to hear a real human, and to vicariously experience our own humanity more fully through what that dear human does.

N umber three, we know both the quotidian and the sometimes noble, poignant origins of “mistakes” in elite performers; we understand how they happen, at least those of us who have ever studied music do. And we actually want to witness them. We love virtuosic spectacle, yes, but, more than that, we glimpse first-hand in the virtuosos’ limits and accomodations and recoveries from occurrences around those boundaries some important dimensions that we have and that all people, past, present, and future have.

N umber four: authenticity is not conditioned upon enslavement to the urtext. In any good performance, we witness improvisatory but at the same time fully consequential music. We see the person’s full absorption as it unfolds in front of us. And, given the finiteness of human attention and other capacities, the “full absorption” is not evenly spread across all of the myriad elements to be attended to. As a result, we witness the highly personal irregularities of the elements that receive extra attention, while other less-attended elements recede toward the boundaries where the so-called “mistakes” happen. A lot of what we call “depth” in performance arises via these core-vs-boundary processes. Again, it is part of the beauty.

N umber five: the composer created these risks in the score. In some cases the risks were put there deliberately, in full recognition of what awkwardnesses under the hand (or for the voice, etc.) would do to the performer—some of Rzewksi’s writing is diabolical in this way—and in other cases it was happenstantial/incidental. But the aesthetic whole—the unity of the score’s architecture, replete with its hazards and insurmountable challenges—is what we seek.

N umber six: We can measure the “mistakes” and statistically model the ‘reconstruction error’ or fidelity to the score. In principle, we could study the situations in which the reconstruction error density is high and yet our emotional and aesthetic reception of the performance is also [paradoxically] high.

F irst, we record the occurrences of deviations from the score and transform them from the time-domain to the event-frequency-domain. Then y_t is the power spectrum of those deviations. And we calculate the Kullback-Leibler (KL) divergence (see Lee and Seung 1999)… the 50-cent equation up at the top of this blogpost.

F or those who are especially interested in these issues, have a look at the paper by Maria Ruiz, Hans-Christian Jabusch, and Eckart Altenmueller at Hanover and Dresden (link below).

N umber seven: some of what we hear as “wrong” is not wrong after all, even if the performer herself/himself obsesses over it.

W e first have to diagnose the right notes as ‘right’ before we can say that any of them are wrongly played—‘diagnose,’ rather than merely find: no longer does the fact that a composer puts down a C on paper [or in Finale or Sibelius, etc.] necessarily mean that s/he cares two hoots if a C sharp is played instead, or a C-semi-sharp for that matter. And even if s/he thinks s/he cares, one takes leave to doubt the profundity of his/her worries when, in rehearsal, one notices that s/he does not perceive the difference between the alleged right note and the wrong note s/he gets instead.”
— Hans Keller.

E vents remaining in Victor Goldberg's Asian tour include:

Masterclass, City Hall, Hong Kong - 20-JAN
Masterclass, Hong Kong University - 21-JAN
Concert, Discovery College, Hong Kong - 23-JAN

B est wishes, Victor. See you back in the U.S. at the end of the month.

Saturday, May 22, 2010

Lumbricals, Some Getting Stronger, Others Discouragingly Staying the Same

G reat strength is necessary in the fingers, yes, but it comes with playing, if one plays rightly—that is, musically. From the moment one senses that the finger must ‘sing’, it becomes stronger. That is quite a different matter from playing exercises or etudes merely for the sake of strengthening, and saying ‘I must exercise my fingers and make them strong.’ Such playing as this latter sort does not help at all.”
— Vladimir Horowitz.

M y guitarist-pianist friend and colleague at work comes and visits with me this week, says that for more than a month he’s been doing exercises to strengthen the lumbrical muscles in his hands. The left hand has been responding, but the right hand—especially the ring finger and pinky—has been staying the same or, paradoxically, might even be getting weaker.

H e worries about focal dystonia. (Jason Solomon of Georgia Guitar Quartet has an excellent article about that here.) He worries about carpal tunnel syndrome (CTS). I am not a neurologist, but I know enough to know when to go and hire one. I ask my friend about whether he has any numbness or difference in sensation among the fingers on the right hand, or between the right and left...

T he fact that my friend is a professional software developer/engineer who spends 70+ hours at a laptop keyboard each week is something the neurologist will need to know, as part of the evaluation—in addition to the heavy hours on guitar and piano. In other words, if what my friend is experiencing is some type of repetitive stress injury (RSI), then characterizing the various types and intensities of repetitive motions will be clinically important.

T he state-of-the-art of hand biomechanics and hand problems of musicians have been a recurring interest for me for some years, so, in response my friend’s immediate situation, I go online and scan the current medical journal literature, to see what, if anything, is new in the last year or two. For his benefit and maybe for your own, I gather some relevant things together in the list of links below.

W here exactly is the ‘carpal tunnel’? The carpal tunnel is the narrow space anatomically between the small carpal bones of the wrist and the ligament called the flexor retinaculum. Here’s how you can find it: Put your left index finger in the center of your right palm, then move the finger about two inches down your palm toward your arm, stopping when your finger approaches the edge of the fleshy part of your hand. Your finger now lies directly over the carpal tunnel. The carpal tunnel is the U-shaped depression with carpal bones below and on either side. The flexor retinaculum ligament stretches over the top of the ‘U’ to make a tunnel-like space. The cross-section of the tunnel is only a centimeter or so, and nine flexor tendons (two to each finger and one to the thumb) have to pass through that little tunnel. The space is so narrow that some of the tendons are bundled on top of each other instead of going side-by-side the way they do outside the tunnel.

B esides tendons, the median nerve also goes through the carpal tunnel. By contrast, the ulnar nerve does not run in the carpal tunnel. The median nerve supplies most of the palm, the thumb, the index finger, the middle finger, and part of the ring finger. The first and second lumbricals (i.e. the two that are most ‘lateral’ on the radial side; index and middle fingers) are innervated by the median nerve. The third and fourth lumbricals (i.e. the most medial two; middle, ring, and little fingers) are innervated by the deep branch of the ulnar nerve. So if what’s going on is actually CTS, then you might expect weakness predominantly in lumbricals and/or interosseous muscles serving the thumb or index finger or middle finger or maybe the middle fingerward side of the ring finger. And you might think ‘ulnar neuropathy’ if the ring finger and/or pinky are predominantly affected.

B ut, gee, knowledge of the neuroanatomy of peripheral nerves in your arm and wrist and hand only gets you part of the way toward figuring out what is going on. In part, this is because of the interconnections elsewhere, including the motor cortex in your brain. Besides clinical evaluation, electrodiagnostic (EDX) tests are usually needed to confirm the diagnosis.

T he lumbrical and interosseous muscles are important in several motions—including flexing and plucking, increasing and diminishing the ‘spread’ of the fingers, and extending/raising the fingers. The lumbricals are used during an ‘upstroke’ when you are writing with a pen or pencil. These are the muscles that make the fingers separate and spread out or, alternately, converge and come together. The lumbrical muscles, with the help of the interosseous muscles, simultaneously flex the metacarpophalangeal (MCP) joints while extending both interphalangeal (IP) joints. In bats and other animals, these muscles are the ones that enable them to spread the wings and grab the air at one instant and flex and draw them in a few tens of milliseconds later and let the air go. If a bat acquired a repetitive stress injury of its lumbricals, on both sides or one side different from the other, it wouldn’t have long to live. Same thing for a seal: you can’t swim and catch fish if your lumbricals are faltering. Serious musicians—people whose livelihood or soul depends on playing—worry about this, as intently as a seal or bat.

T he EDX testing for these conditions is steadily getting more sensitive and more precise. For example, Sheehan and coworkers (link below) studied people referred with suspected carpal tunnel syndrome (CTS) by measuring the ‘second lumbrical-interosseous distal motor latency difference’ (2LI-DML) as well as by other, more standard tests like ‘median-ulnar palmar velocity difference’. The referred cases included 74% who turned out to be CTS. Sheehan suggests that 2LI-DML, which is a more sensitive test than other nerve conduction velocity tests for detecting mild abnormalities, is useful as a screening test for latent CTS on the asymptomatic side.

M otor distal latency (MDL) differences between the median-thenar and ulnar-hypothenar (M-U) muscles and between the median-second lumbrical and ulnar-interossei muscles (2L-INT) have also recently been used to diagnose early or ‘mixed’ cases. After all, there is no law of Nature that says a person can’t have CTS and UNE or CTS and focal dystonia at the same time. In people in whom the conventional nerve conduction tests are so far ‘normal’ despite the symptoms they are having, the neurologist can measure both motor and sensory W-P conduction and in a large percentage of cases this can establish a diagnosis.

U lnar neuropathy at the elbow (UNE) is the second most common compressive neuropathy of the upper limb. Compared to ‘ulnar neuropathy at the elbow’ (UNE), ulnar neuropathy at the wrist (UNW) is rarer and more difficult to localize with routine electrodiagnostic (EDX) tests. In terms of expectation-setting, it is reasonable to anticipate that it may take some time (and multiple visits) to establish an accurate diagnosis and decide on the right treatment plan. In general, these are not things that can be sorted out in a single, quick office visit.

T he important thing—if you are having symptoms like the ones my guitarist friend is having—is to get yourself examined by a neurologist who is experienced in problems of performing artists and who has the equipment and training to perform the newer EDX tests that are available. You can search for practitioners who are diplomates of the American Board of Electrodiagnostic Medicine here. I regret that I don’t know what comparable search resources there may be for consultants having EDX professional certifications in other countries.