Load and fatigue monitoring in musicians using an online app: A pilot study.

Background/aims: High occupational injury rates are reported in musicians, with a career prevalence of up to 89%. Fatigue and playing (over)load are identified as key risk factors for musicians' injuries. Self-report fatigue management strategies in sport have demonstrated preventive effects. A self-report fatigue management tool for musicians was developed based on a Delphi survey of international experts and hosted in an online app. The aims of this study are to evaluate the content validity and uptake of this new tool, and explore associations between collected performance quality, physical/psychological stress, pain, injury and fatigue data. Methods: University and professional musicians were asked to provide entries into the online app twice per week for 1-6 months. Entries into the app were designed to take 2-3 min to complete and consisted of the following: 6 questions regarding playing load over the previous 72 h; 5 questions regarding current levels in key physical/psychological stress domains (sleep, recovery, overplaying, pain, fitness); one question self-rating of performance quality over the previous day; one question regarding current musculoskeletal symptoms; a reaction time task to evaluate psychomotor fatigue. Results: N = 96 participants provided an average of 2 app entries (range 0-43). Increased playing time, rating of perceived exertion (RPE), and feelings of having to "play too much" were consistently associated with increased self-rated performance quality (p ≤ 0.004; 6.7 <| t |< 2148.5). Increased ratings of feeling fit and recovering well were consistently associated with reduced pain severity (p < 0.001; 3.8 <| t |< 20.4). Pain severity was increased (6.5/10 vs. 2.5/10; p < 0.001) in participants reporting playing-related musculoskeletal disorders (PRMDs; symptoms affecting playing). Conclusion: The prospective value of regular individual self-report playing load, stress, and performance data collection in musicians is clear. However, limited uptake of the online fatigue management app piloted in this study indicates that new approaches to the collection of these data are needed to realize their potential impact.

GuitarPD: A Randomized Pilot Study on the Impact of Nontraditional Guitar Instruction on Functional Movement and Well-Being in Parkinson's Disease.

Playing musical instruments may have positive effects on motor, emotional, and cognitive deficits in patients with Parkinson's disease (PD). This pilot study examined the feasibility of a six-week nontraditional guitar instruction program for individuals with PD. Twenty-six participants with idiopathic PD (Age: 67.22 ± 8.07; 17 males) were randomly assigned to two groups (intervention first or 6 weeks of usual care control exposure) with stepwise exposure to the guitar intervention condition with cross-over at six weeks. Outcomes were assessed at baseline, 6, 12, and 18 weeks. Twenty-four participants completed the study. Combined analysis of the groups showed significant BDI-II improvement immediately after intervention completion (3.04 points, 95% CI [-5.2, -0.9], p = 0.04). PDQ-39 total quality of life scores improved from baseline to immediately postintervention 5.19 points (95% CI [-9.4, -1.0]) at trend significance (corrected p = 0.07). For Group 1 (exposed to the intervention first), MDS-UPDRS total scores improved by a mean of 8.04 points (95% CI [-12.4, -3.7], p = 0.004) and remained improved at 12 weeks by 10.37 points (95% CI [-14.7, -6.0], p < 0.001). This group also had significant improvements in mood and depression at weeks 6 and 12, remaining significant at week 18 (BDI-II: 3.75, 95% CI [-5.8, -1.7], p = 0.004; NeuroQoL-depression: 10.6, 95% CI [-4.9. -1.4], p = 0.004), and in anxiety at week 6 and week 18 (NeuroQoL; 4.42, 95% CI [-6.8, -2.1], p = 0.004; 3.58, 95% CI [-5.9, -1.2], p = 0.02, respectively). We found clinically and statistically significant improvements in mood/anxiety after 6 weeks of group guitar classes in individuals with PD. Group guitar classes can be a feasible intervention in PD and may improve mood, anxiety, and quality of life.

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

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

Not all imagery is created equal: A functional Magnetic resonance imaging study of internally driven and symbol driven musical performance imagery.

Playing a musical instrument requires fast multimodal sensory-motor processing which can be activated by voluntary access to performance imagery. Musicians use different methods to activate imagery for the purpose of "mental practice". The aim of the present study was to investigate cortical activation patterns in different methods of mental practice of musical performance. While undergoing functional magnetic resonance imaging (fMRI), 7 male oud (fretless lute) players engaged in performance imagery of a pre-memorized short excerpt from mainstream oud repertoire using three common imagery methods (task conditions): From memory (internally driven) 1)eyes closed, 2)eyes open, and while following the musical score (symbol driven). The study design consisted of a four-task 16-epoch block design where the 4th task was an eyes-open rest tasks (EOR) included as a control condition. Each task was repeated four times in a pseudorandomized sequence. The superior temporal gyrus and transvers temporal gyrus (Heschl) were active in the left and right hemispheres in all imagery conditions. The occipital cortex, specifically the fusiform gyrus was active in all three conditions. Symbol driven imagery resulted in less prominent activations in frontal and parietal lobes. The findings suggest that not all imagery modalities activate sensory and motor areas similarly.

Diffusion tensor and volumetric magnetic resonance imaging findings in the brains of professional musicians.

Professional musicians represent an ideal model to study the training-induced brain plasticity. The current study aimed to investigate the brain volume and diffusion characteristics of musicians using structural magnetic resonance and diffusion tensor imaging (DTI). The combined use of volumetric and diffusion methods in studying musician brain has not been done in literature. Our study group consisted of seven male musicians playing an instrument and seven age- and gender-matched non-musicians. We evaluated the volumes of gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) and calculated total intracranial volume (TIV) and measured the fractional anisotropy (FA) of pre-selected WM bundles: corpus callosum (CC), corticospinal tract (CST), superior longitudinal fasciculus (SLF), forceps major (ForMaj), forceps minor (ForMin), and arcuate fasciculus (AF). The mean WM/TIV volume in musicians was higher compared to non-musicians. The mean FA was lower in CC, SLF, ForMaj, ForMin, and right AF but higher in right CST in the musicians. The mean value of the total number of fibers was larger in the CST, SLF, left AF, and ForMaj in the musicians. The observed differences were not statistically significant between the groups (p>0.05). However, increased GM volume was found in the musicians compared to the non-musicians in the right and left cerebellum and supramarginal and angular gyrus, left superior and inferior parietal lobule and as well as left middle temporal gyrus. Our findings suggest differing brain structure in musicians and the confirmation of the results on a larger population.