Performing Arts Medicine Association Research Articles

Athletes and the Arts and Performing Arts Medicine: Leveraging Sports Medical Expertise to Improve the Care of Performing Artists.

Athletes and the Arts and Performing Arts Medicine: Leveraging Sports Medical Expertise to Improve the Care of Performing Artists.

An Intensive Continuing Education Course to Enhance Care of the Performing Arts Athlete: The "Essentials of Performing Arts Medicine".

Abstract A new continuing education course from Performing Arts Medicine Association and American College of Sports Medicine enables sports medical health professionals to better care for performing artists. High occupational injury rates have been reported in performing artists, yet the quality of preventive and clinical care remains highly variable. Through the Athletes and the Arts collaboration, The Performing Arts Medicine Association, and the American College of Sports Medicine identified that health care practitioners’ existing expertise should be enhanced to address the complex psychophysical needs of performing artists. In response, a 2-d continuing education course, “The Essentials of Performing Arts Medicine” (EOPAM), was developed and has been delivered at least annually since 2016. This course has been well-received by 149 physicians and 240 allied health professionals to date (average ratings, ≥3.5/5 from 2018 to present), with course quality significantly improved by a transition to online delivery in 2020 (average ratings ≥4.5/5; P < 0.01). Accordingly, EOPAM demonstrates that a brief continuing education course can enhance health professionals’ understanding of the unique needs and demands of performing artists, addressing a key barrier to improved care.

Assessing Performing Artists in Medical and Health Practice - The Dancers, Instrumentalists, Vocalists, and Actors Screening Protocol.

Training in the performing arts exposes individuals to often extreme physical and psychological demands, which are linked to high occupational injury rates. The intense demands of performing artists have been likened to those of sport athletes. However, distinct differences in these demands necessitate specialized approaches to the health care of performing artists. Through the Athletes and the Arts collaboration, the American College of Sports Medicine and Performing Arts Medicine Association identified that the creation of a specialized preparticipation screening tool for performing artists would likely enhance health care for performing artists significantly. Based on a thorough review of established assessments and an extensive consultation process with domain experts, a consensus best-practice screening tool was developed: the Dancer, Instrumentalist, Vocalist, Actor (DIVA) Preparticipation Screening. This screening tool is modeled on the athletic preparticipation examination (PPE) in its structure and 30-min target duration. However, DIVA diverges considerably from the PPE in its content to address the specific risks and needs of performing artists. In particular, screening questions and physical examination procedures focus strongly on musculoskeletal injuries and mental health conditions, in response to the preponderance and interactions of these conditions appearing in performing artists. The DIVA tool presented is intended as a "living tool," which can be modified in the future to include new effective assessment techniques as appropriate. Training in the DIVA preparticipation physical examination is included as a core component of the essentials of performing arts medicine continuing education course described in detail in a companion manuscript in this issue.

Knowledge Platform and Theoretical Basic Course About Embouchure and Embouchure Problems in Brass: Special Symposium of the Nederlandse Vereniging voor Dans- en Muziekgeneeskunde (NVDMG), Ede, The Netherlands, December 3, 2021

On Friday, December 3, 2021, the Dutch Performing Arts Medicine Association (NVDMG) organized the first “Knowledge Platform Symposium About Embouchure and Embouchure Problems in Brass,” at Akoesticum in Ede, The Netherlands. The intention of this symposium was to create a bridge between the brass world (brass players and brass pedagogues of several Dutch and Belgian conservatories) and physicians and therapists active in the treatment of embouchure problems. In the afternoon a “Theoretical Basic Course” about this topic was organized about the fundamentals of embouchure and how to observe in a structural way at the individual embouchure.

Coming Home; Together Again!

Coming Home; Together Again! Carole Blankenship (bio) From the President In the last few weeks and months, we have experienced a genuine reunion with loved ones, friends, and whole communities that we have missed during most of 2020 and half of 2021. Some of these gatherings have been bittersweet reunions due to the loss of dear friends and family. The gatherings may well include immense relief that we have survived one of the hardest times of our lives. Amid the many tribulations and the financial failures of the time, COVID-19 may have been cruelest to the performing arts. Many performing artists have not had access to required rehearsal spaces, teaching studios, and stages and concert halls, resulting in loss of income, livelihood, and even self-worth. COVID-19 kept us away from people who encourage us in our art, including our collaborators and mentors. Students of all ages have been relegated to online learning from their homes, often in bedrooms. Students in the performing arts have been left to learn lines and music in a vacuum, outcomes being video auditions or virtual performances on Zoom. Most of us were completely without opportunities to be part of something bigger than ourselves and all that goes with live collaboration and performance. As I write this, many of my colleagues in the arts are planning to be with others in person after functioning virtually for many months. Calendars are filling with dates and times for rehearsals and performances! We are planning performances on our stages and in our halls, and, thrilled to collaborate with each other again, we will gather to sing solo or in harmony in acoustic spaces built just for that purpose! And NATS is here to welcome you back home to live workshops, live auditions, and an in-person national conference! As we schedule and program concerts, NATS has been working for months to help guide the re-entry to in-person performances and auditions. In collaboration with partner organizations the NATS Voice Science Advisory Committee has penned the following statement. JOINT STATEMENT ON SARS-COV-2 VACCINATIONS AND BEST HEALTH PRACTICES The National Association of Teachers of Singing Voice Science Advisory Committee, the American Choral Directors Association, Chorus America, the Barbershop Harmony Society, the Performing Arts Medicine Association, the Pan American Vocology Association, Opera America, and National Collegiate Choral Organization strongly recommend that all singing teachers, choral conductors, collaborative pianists, and singers eligible to receive an FDA authorized vaccine follow CDC guidance and become fully vaccinated as soon as possible. [End Page 153] We collectively support public health education efforts at the local, state, and national levels that offer accurate information about vaccine efficacy and safety and that encourage all persons to become vaccinated. We recommend that unvaccinated teachers, conductors, collaborative pianists, and singers continue to follow COVID-19 prevention and mitigation practices that have been effective in reducing the spread of the disease in indoor public areas. These include but are not limited to the use of masks, physical distancing, increased ventilation, reduced contact time, regular cleaning of common surfaces, and vigorous hand washing. [For the full statement with bibliographic reference, see https://www.nats.org/_Library/COVID_19_Resource_Docs/VSAC_STATEMENTv2_-_June_23_2021.pdf.] We are indebted to the scientists who have generated the vaccinations that make coming together possible. Those of us who are vaccinated can re-enter the world of live singing with a certain confidence. Those of us who are not vaccinated will be advocating for themselves and communicating their special status to others—a regrettable consequence of almost two years of the pandemic and the extremely divisive political rhetoric around the vaccines. However, singing professionals have access to the facts that receiving the vaccines and asking students and clients to divulge their vaccination status will keep all around them well and free of the virus. Many NATS chapters and regions already have enjoyed live fall events and auditions. Regarding the NATS Artist Award auditions, NATS has created a virtual region for our members in Canada who may not be able to travel to a live preliminary audition and for singers who have medical issues due to COVID-19. NATS invites you home to New York...

Genees & Kunst 21, 3rd Lustrum--Annual Symposium on Medical Problems of Dancers & Musicians, Ede, The Netherlands, March 26, 2021.

On Friday, March 26, 2021, the Dutch Performing Arts Medicine Association (NVDMG) organized a scientific and artistic symposium "Genees & Kunst 21" for its 21st member assembly, at Akoesticum in Ede, The Netherlands. It was also the 3rd lustrum symposium, because in 2020 the NVDMG had its 15th anniversary and due to COVID-19 we had to postpone the symposium 1 year. The symposium was held digitally for the first time in the existence of the NVDMG.

Art on Prescription. Dutch Performing Arts Medicine Association (NVDMG) Symposium, Leeuwarden, The Netherlands, October 29, 2019

The focus of the symposium, organized by the Rehabilitation Expertise Center for Music & Dance of Revalidatie Friesland (NL) under the auspices of the Dutch Performing Arts Medicine Association (NVDMG), was the added value of the application of art in health care and the social domain. The abstracts of the presentations provide information about different aspects related to this topic.

Health Status of Live Theater Actors: A Systematic Literature Review

Actors constitute an at-risk population based on the physical burden demanded from their profession, different health behaviors, and poor economic and health insurance status. The purpose of this systematic literature review was to search for evidence of the health and fitness of theater actors. Pubmed, EBSCO (CINAHL and SPORTdiscus), the database of the Performing Arts Medicine Association, the Journal of Physical Education, Recreation, and Dance, and Medical Problems of Performing Artists were searched. Included studies had data extracted and were scored for methodological quality. The search identified 18 studies, examining actors at different career stages, including secondary school (n=2), university (n=3), and professional (n=13). Eight studies received a low methodological quality score (50% or less). Most studies reported cigarette smoking among 10-26% of their samples and regular alcohol use in 25-40%. However, among professionals, prevalence and risk of harm from levels of alcohol consumption were much higher. Marijuana consumption was reported by 11-25% of respondents, while use of other drugs ranged from 7-23%. Most respondents suffered 1-2 injuries each year, with one study indicating that 72% of injuries occurred during class or rehearsal. This systematic literature review highlights a large gap in the research about actors' health. The high rates of substance use and injuries among actors indicate not only a large health burden but a hindrance to their ability to perform, which may negatively impact their livelihood.

Profiles in Performing Arts Medicine Courage--A Tribute to Dr. Alice Brandfonbrener.

I was honored and privileged to join Dr. Robert Sataloff in delivering a tribute to Dr. Alice Brandfonbrener at the 2015 Symposium on the Medical Problems of Performing Artists in Snowmass, Colorado. As virtually everyone who reads this journal knows, Dr. Brandfonbrener organized the first symposium (then focused on the medical problems of musicians), was the founding editor of Medical Problems of Performing Artists, and was the first president of the Performing Arts Medicine Association. She died in 2014, just prior to last year's symposium. This year, after Dr. Sataloff presented a very engaging overview of Alice's career and impressive accomplishments, I gave a short address that was based on some of the editorials Alice wrote in this journal during her 20 year tenure as editor. I have chosen a few examples of how the courage that she demonstrated in launching an international medical conference, a peer-reviewed medical journal, and a professional association continued to present itself in her writing.

Research in Performing Arts Medicine

The field of performing arts medicine has grown significantly over the last few decades. While we still have a long way to go before we can confidently state that we know how to prevent and treat the maladies that interfere with artistic performance, we are making progress on several fronts. In preparation for giving one of the keynote addresses at the 2015 University of South Florida--Performing Arts Medicine Association Conference titled Caring for Artists and Arts that Heal, I reviewed the types of articles that have been published in Medical Problems of Performing Artists over the last 10 years. I also did a comparison of those articles to articles published in the Journal of Dance Medicine and Science and in the American Journal of Sports Medicine. In this editorial, I will present my findings.

Addressing the NASM health and safety standard through curricular changes in a brass methods course: an outcome study.

The National Association of Schools of Music (NASM) recently ratified a new health and safety standard requiring schools of music to inform students about health concerns related to music. While organizations such as the Performing Arts Medicine Association have developed advisories, the exact implementation is the prerogative of the institution. One possible approach is to embed health education activities into existing methods courses that are routinely offered to music education majors. This may influence student awareness, knowledge, and the perception of competency and responsibility for addressing health risks associated with learning and performing musical instruments. Unfortunately, there are no known lesson plans or curriculum guides for supporting such activities. Therefore, the purpose of this study is to (1) develop course objectives and content that can be applied to a preexisting brass methods course, (2) implement course objectives into a semester-long brass methods course, and (3) test the effectiveness of this intervention on students' awareness, knowledge, perception of competency, and responsibly of health risks that are related to learning and performing brass instruments. Results showcase the potential for modifying methods courses without compromising the other objectives of the course. Additionally, students' awareness, knowledge, perception of competency, and responsibility were positively influenced as measured by changes in pre to post responses to survey group questions.

Alice G. Brandfonbrener, MD-A personal remembrance.

Alice Brandfonbrener died peacefully at home on May 31, 2014, after a protracted illness. For all of us involved in performing arts medicine, she was the inspiration and guiding spirit. She will be missed. [Alice Brandfonbrener was one of the founding members of the field of performing arts medicine, perhaps the most critical founding member. In 1983, she organized the first "Conference on the Medical Problems of Musicians" in Aspen, Colorado, and co-directed these for the next 20 years. These symposia led to the formation of the Performing Arts Medicine Association, of which Dr. Brandfonbrener was the first president, and in 1986, establishment of the first journal in the field--this journal, Medical Problems of Performing Artists--for which she served as Editor for 20 years. At her performing arts clinic in Chicago, she saw and treated thousands of musicians, from young students to world-renowned professionals, and mentored many students and professionals who would extend research and practice in performing arts medicine.].

Benefits of music training are widespread and lifelong: a bibliographic review of their non-musical effects.

Recent publications indicate that musical training has effects on non-musical activities, some of which are lifelong. This study reviews recent publications collected from the Performing Arts Medicine Association bibliography. Music training, whether instrumental or vocal, produces beneficial and long-lasting changes in brain anatomy and function. Anatomic changes occur in brain areas devoted to hearing, speech, hand movements, and coordination between both sides of the brain. Functional benefits include improved sound processing and motor skills, especially in the upper extremities. Training benefits extend beyond music skills, resulting in higher IQs and school grades, greater specialized sensory and auditory memory/recall, better language memory and processing, heightened bilateral hand motor functioning, and improved integration and synchronization of sensory and motor functions. These changes last long after music training ends and can minimize or prevent age-related loss of brain cells and some mental functions. Early institution of music training and prolonged duration of training both appear to contribute to these positive changes.

Certification in Performing Arts Medicine

The idea of specialty certification in performing arts medicine (or performing arts healthcare) has been discussed for a long time among professionals in the field. An article by Pascarelli and Bishop published nearly 20 years ago mentioned the perceived need for certification and some of the obstacles to creating it. The Performing Arts Medicine Association (PAMA) took a step in this direction at the 31st Annual Symposium on the Medical Problems of Performing Artists by offering a preconference workshop, “The Essentials of Performing Arts Medicine Course: From Classroom to Stage.” This full-day educational session was attended by several dozen performing arts medicine professionals and led by experts from several disciplinary backgrounds in both music and dance. While PAMA has no plan in place currently to offer specialty certification in performing arts medicine, educational offerings such as this one are often part of the requirements to become certified in an interdisciplinary specialty area.

Performing Arts Medicine-–A Bibliographic Retrospective of the Early Literature: An Historical Examination of Bibliographic References Pre-1975

Performing arts medicine (PAM) emerged as a medical specialty around 1985. Prior to this time, relatively few publications addressed the identification and concerns of musicians' and dancers' medical problems. To determine what number and types of publications occurred prior to the actual beginnings of PAM as a discipline, and to determine how these original topics compared with present-day publications, a retrospective review of the current bibliographic database of the Performing Arts Medicine Association (PAMA) was undertaken. Out of a total of 12,600 entries to date, 489 references were found published from 1798 through 1974, which represent only 3.9% of the current database listings. One-sixth of the references were originally written in a language other than English. Journal articles were by far the most numerous type of publication. Topics with the highest number of entries included the neurobiology of music (n=77), dental/orofacial matters (71), and biographical accounts of composers or musicians and their illnesses (59). Other frequently published topics included hearing loss, physiology of playing instruments, and instrumental technique and teaching. Early topics with multiple publications included composers' biographies, dystonias, and surgery to improve finger independence for playing piano. Subjects whose publications occurred principally in the last two decades of this review included dermatological disorders, hearing loss, and ballet physiology, teaching, and technique. Those which remain popular to the present day include hearing loss, performance anxiety, focal dystonia, and dental/orofacial problems.

Performing Arts Medicine--Past, Present and Future

We have a lot to be proud of as we look back on the last three decades, as we look around at what is happening in the field of performing arts medicine now, and as we look forward to the potential that the future holds. From the early 1980s, when Dr. Brandfonbrener decided it was time to focus on improving the health of musicians by organizing the first Aspen meeting, to the first issue of this journal and the founding of the Performing Arts Medicine Association over the next 5 years, the founding of the International Association for Dance Medicine and Science in 1990, and the Health Promotion in Schools of Music initiative in the last decade, performing arts medicine has enjoyed steady growth. As we work to design the future of performing artist health, it may be useful to look at a “sister” specialty that got an earlier start—-sports medicine.

Oefening Baart Kunst—“Exercise Bears (Gives Birth To) Art”: Symposium for and by the Allied Health Professions of the NVDMG, Medisch Centrum Haaglanden, Den Haag, February 5, 2011

On Saturday, February 5th, 2011, the Dutch Performing Arts Medicine Association (Nederlandse Vereniging voor Dans- en MuziekGeneeskunde, NVDMG) organized a Symposium for and by allied health care professionals, held in the Medisch Centrum Haaglanden (MCH, Medical Centre of The Hague). Allied health care professionals, such as physiotherapists, manual therapists, Mensendieck therapists, speech therapists, and foot therapists, form a vital and indispensable link in the chain of healthcare and cure for dancers, musicians, and singers. The intention of the symposium was to highlight the practical and experience-related approach of allied health care providers, both in the presentations and in the artistic intermezzi. Apart from the exchange of knowledge and experience, there was ample opportunity for informal contact, facilitating and stimulating the formation of an interdependent network of allied health care providers specialized and/or interested in dance, music, and singing in The Netherlands.

Genees & Kunst 10--Tenth Symposium on Medical Problems of Dancers & Musicians, Universitair Medisch Centrum, Utrecht, March 27, 2010.

On Saturday, March 27th, 2010, the Dutch Performing Arts Medicine Association (NVDMG) organized a scientific and artistic Jubilee symposium "Genees & Kunst 10" for its 5th anniversary and 10th member assembly, at the University Medical Centre Utrecht, The Netherlands. During his opening speech, dr. Rietveld, president of NVDMG, mentioned the successful first 5 years and the vitality of the NVDMG, and he emphasized the importance of performing arts medicine, given the large proportion of performing artists (at least 14% of all patients) in an average Dutch family physician's practice. Scientific presentations, interspersed with dance and music performances, were given by several medical specialists. Abstracts of these presentations are published here as the symposium proceedings.

Genees & Kunst 8: Eighth Biannual Symposium on Medical Problems of Dancers & Musicians, Revalidatie Friesland, Beetsterzwaag, April 4, 2009

On Saturday, April 4th, 2009, the Dutch Performing Arts Medicine Association (NVDMG) organized a scientific and artistic symposium Genees & Kunst 8 for its 8th member assembly, at Revalidatie Friesland (Rehabilitation Friesland) Rehabilitation Centre, in Beetsterzwaag, The Netherlands. The assembly was co-hosted by Mr. G.J.F. (Gert-Jan) de Haas, Vice-chairman of NVDMG and head of the Psychology and Psychiatry Department of the Medical Centre for Dancers & Musicians (MCDM), K.H. (Kees-Hein) Woldendorp, MD, rehabilitation specialist and musician in Revalidatie Friesland, and Prof. S.K. (Sjoerd) Bulstra, MD, PhD, orthopaedic surgeon and head of the Orthopaedic Department of the University Medical Centre Groningen (UMCG). In addition, Revalidatie Friesland celebrated the 10th anniversary of the musicians' outpatient clinic led by K.H. Woldendorp, MD.

Toward a Performing Arts Medicine Definition of Performing Arts

As the Performing Arts Medicine Association (PAMA) celebrates its 20th anniversary this year, it seems to be a good time to discuss a definition of what the field includes—and, by extension, what it doesn't include. Some may think that this might not be the best use of our time, since we have done pretty well so far without a written definition of the performing arts. However, a presentation at the 27th Annual Symposium on the Medical Problems of Musicians & Dancers on health issues of circus performers and some recent articles in Medical Problems of Performing Artists on artistic and rhythmic gymnasts have helped us broaden the scope of our field. While I find this exciting and another indication that performing arts medicine is a vibrant, essential specialty within the universe of health care, it also makes me wonder what else ought to be included in the field and what shouldn't.