Wind Musicians Research Articles

Live wind music within an acute ward for people with dementia

Abstract This project sought to examine the effects of live music as an intervention to improve the well-being of people with dementia who had been admitted to an acute dementia assessment ward following severe psychological and behavioural distress. The literature search revealed little into the use of a group of musicians, none using a wind quintet (flute, oboe, clarinet, bassoon and horn), and few studies involving a group of wind musicians and people with dementia experiencing severe distress. Measurements were taken using Dementia Care Mapping (DCM) and the Bradford well-being and ill-being profiles. Data collected from individuals with dementia, carers, staff and players provided evidence to show that intervention using live group music had a positive effect upon individuals’ well-being. The number of participants was restricted to twelve – the capacity of the assessment unit – and there was no control group. This pilot study could lead to a larger, controlled research study. The interesting findings were observations of well-being in favour of ill-being in responses to the live music interventions. The precise mechanisms responsible for these affects appear complex, relating to both the musical and socially therapeutic dimensions of the intervention. An important secondary finding related to the positive effect of the whole process on musicians’ development in person-centred skills appropriate for working with people with severe dementia. The project also extended ward staff’s facilitation skills encouraging individuals’ participation in a new situation with a group of players on the ward.

Mechanics of circular breathing in wind musicians using cine magnetic resonance imaging techniques.

To investigate the mechanics of circular breathing using cine magnetic resonance imaging (cMRI). Pilot study. Eight musicians were asked to sustain a note by circular breathing while being studied inside a Siemens Trio 3T magnetic resonance imaging scanner. Subjects were imaged in the midsagittal plane using an innovative T1-weighted cMRI. Our study population included six professionals and two experienced amateurs (two saxophonists, two trombonists, and four trumpeters). Five predetermined oropharyngeal distances were measured frame by frame. Data were analyzed for displacement and percentage change over time. Oral airway area was measured using automated bounding box techniques. All subjects were observed to complete the same series of steps characterized by 1) superior/posterior tongue displacement, 2) inferior/anterior soft palate displacement, 3) anterior tongue/soft palate displacement, 4) superior/posterior soft palate displacement, and 5) return of the tongue to baseline. Posterior oropharyngeal occlusion was demonstrated in bounding box data. Relative occlusion time was significantly longer among experienced amateurs than professionals (P = .01), with a similar trend in absolute occlusion time (P = .08). A trend toward a longer circular breathing cycle time was observed among saxophonists and trumpeters (P = .2), although the difference among trumpeters disappeared when amateurs were excluded. Circular breathing has been investigated as therapy for obstructive sleep apnea. This study defines the mechanics of circular breathing for use in training--and potentially in therapy--if proven useful. We demonstrated similar mechanics across subgroups, and increased efficiency among professionals. Our findings demonstrate the feasibility and reliability of cMRI in the dynamic assessment of oropharyngeal motion. NA.

The difference between standing and sitting in 3 different seat inclinations on abdominal muscle activity and chest and abdominal expansion in woodwind and brass musicians.

Wind instrumentalists require a sophisticated functioning of their respiratory system to control their air stream, which provides the power for optimal musical performance. The air supply must be delivered into the instrument in a steady and controlled manner and with enough power by the action of the expiratory musculature to produce the desired level of sound at the correct pitch. It is suggested that playing posture may have an impact on the abdominal muscle activity controlling this expired air, but there is no research on musicians to support this theory. This study evaluated chest and abdominal expansion, via respiratory inductive plethysmography, as well as activation patterns of lower and upper abdominal musculature, using surface electromyography, during performance of a range of typical orchestral repertoire by 113 woodwind and brass players. Each of the five orchestral excerpts was played in one of four randomly allocated postures: standing; sitting flat; sitting inclined forwards; and sitting inclined backwards. Musicians showed a clear preference for playing in standing rather than sitting. In standing, the chest expansion range and maximum values were greater (p < 0.01), while the abdominal expansion was less than in all sitting postures (p < 0.01). Chest expansion patterns did not vary between the three sitting postures, while abdominal expansion was reduced in the forward inclined posture compared to the other sitting postures (p < 0.05). There was no significant variation in abdominal muscle activation between the sitting postures, but the level of activation in sitting was only 2/3 of the significantly higher level observed in standing (p < 0.01). This study has demonstrated significant differences in respiratory mechanics between sitting and standing postures in wind musicians during playing of typical orchestral repertoire. Further research is needed to clarify the complex respiratory mechanisms supporting musical performance.

Impact of sound production by wind instruments on the temporomandibular system of male instrumentalists\footnotemark[1

Playing a wind instrument can be either a reason for overuse or a protecting factor against certain diseases. Some individuals have many findings but low morbidity while others have few findings but high morbidity. This contradictory phenomenon should be researched. The temporomandibular system (TMS) is a functional unit which comprises the mandible, associated muscles and bilateral joints with the temporal bone. The TMS is responsible for the generation of sound when wind instruments are played. Over the long-term and with intensive usage, this causes changes in the musculature and in the temporomandibular joint (TMJ) of wind musicians, often resulting in temporomandibular disorders (TMD). The aim of this study is to examine evidence that TMD constitute an occupational disease in wind musicians. TMD patients and wind musicians were examined by dental clinical functional analysis. 102 male subjects were divided into three groups: "healthy" individuals, wind musicians, and patients with TMD. Dental Examination was carried out based on focused inclusion of the research diagnostic criteria - TMD [1,7]. Findings were evaluated for statistical significance by first transferring data into a digital database [2,15], then generating T-Test und Wilcoxon-Test when non-Gaussian distribution appears and applying the Mann-Whitney rank sum test using Sigmaplot Version 1.1 software (Systat Software Inc, Washington, USA). The evaluation revealed that wind instrument musicians show a high incidence of developing TMD as the researchers found almost 100% morbidity regarding parafunctional habits and preauricular muscle pain of each adult and highly active musician. The result is highly significant (p< 0.001) for protrusion distance of the mandible. A higher prevalence of functional disorders of the musculoskeletal system has previously been demonstrated in wind musicians. New research results and the typical functions of various wind instruments provide evidence that playing a wind instrument generates occupational risks to the TMS.

A Delphi survey on diagnosis and management of stress velopharyngeal insufficiency in wind musicians

The aim of this study was to identify current trends in clinical assessment and management of stress velopharyngeal insufficiency (VPI) in wind musicians. This was an online two-round Delphi survey of health practitioners familiar with assessing and treating musicians with stress VPI. Fourteen specialists (seven otolaryngologists and seven speech-language pathologists) from four countries participated in the Delphi survey. From the first round questionnaire, 32 items were identified as being causes, assessment tools, diagnostic indicators, and treatment methods for stress VPI. The second round questionnaire revealed that prolonged exposure to high intra-oral pressures was important in determining the cause of stress VPI. The most important assessment tools for stress VPI were case history and nasendoscopy. The most important indicator for stress VPI was self-reported symptoms. There was no clear agreement identified on the management methods for stress VPI for musicians. However, the trend followed by most of the survey participants was a combination of conservative management approaches (including rest or watch and wait, speech-language pathology intervention, velopharyngeal muscle training, and changes to the instrument or reed), and then, if symptoms persist, to use injection pharyngoplasty or pharyngeal flap. This survey demonstrates that no standard management protocol currently exists for musicians diagnosed with stress VPI, but provides current trends in the assessment and management which can be used in future guidelines for health professionals who treat wind musicians.

Risk of Obstructive Sleep Apnea Lower in Double Reed Wind Musicians

Obstructive sleep apnea (OSA) is caused by a collapse of the upper airway. Respiratory muscle training with a wind instrument (didgeridoo) in patients with moderate OSA has been previously shown to improve OSA symptomology. However, a survey of orchestra members did not indicate a difference in OSA risk between wind and non-wind instrumentalist. The present study examines whether playing of different wind instrument types may affect the risk of OSA. A national sample of active musicians (n = 906) was surveyed through the internet. Participants' risk for OSA was determined by the Berlin Questionnaire. Additional survey items included questions about general health and musical experience. A binary logistic regression was conducted to determine if OSA risk was predicted by gender, age, number of years playing instrument, number of hours per week playing instrument, and instrument type. Musicians who played a double reed instrument had a lower risk of OSA (p = 0.047) than non-wind instrumentalists. Additionally, in double reed instrumentalists, the number of hours spent playing the instrument predicted lower OSA risk (p = 0.020). The risk for OSA in other wind instruments (i.e., single reed, high brass, and low brass) was not significantly different from non-wind musicians. Playing a double reed musical instrument was associated with a lower risk of OSA.

Biofeedback/Mindfulness Training for the Advanced High School Musician

The author summarizes 35 years of utilizing psychophysiological training to assist in the pursuit of optimal music performance. She integrates systematic musical instruction with self-regulation training, drawing on EEG biofeedback training, heart rate variability training, and other biofeedback modalities. This integration of musical skills training and biofeedback assisted over one hundred high school age musicians to earn “All State” status, enabled numerous wind musicians to gain national recognition, and assisted two autistic children in becoming musical prodigies.

An Examination of before and after Rehearsal Pitch Tendencies of String and Wind Musicians

The purpose of this study was to examine the before and after rehearsal pitch tendencies of college string and wind musicians and compare possible: (1) differences in pitch before and after rehearsal, (2) differences in pitch between string and wind musicians and (3) differences between string and wind musicians’ reported tuning practices. Participants consisted of 59 college musicians (30 string musicians and 29 wind musicians). Prior to a large ensemble rehearsal, all musicians were individually recorded playing a concert A without tuning. Musicians participated in a rehearsal and again recorded their concert A immediately following the rehearsal. Mean pitches of string and wind groups were significantly different before the rehearsal compared to after rehearsal. Both groups of musicians’ mean pitch level increased from before to after rehearsal, particularly for the wind group. Responses collected through a tuning questionnaire found that string musicians reported tuning more often and with others, and wind musicians reported using a tuner more often.

Functional anatomy of the soft palate applied to wind playing

Wind players must be able to sustain high intraoral pressures in order to play their instruments. Prolonged exposure to these high pressures may lead to the performance-related disorder velopharyngeal insufficiency (VPI). This disorder occurs when the soft palate fails to completely close the air passage between the oral and nasal cavities in the upper respiratory cavity during blowing tasks, this closure being necessary for optimum performance on a wind instrument. VPI is potentially career threatening. Improving music teachers' and students' knowledge of the mechanism of velopharyngeal closure may assist in avoiding potentially catastrophic performance-related disorders arising from dysfunction of the soft palate. In the functional anatomy of the soft palate as applied to wind playing, seven muscles of the soft palate involved in the velopharyngeal closure mechanism are reviewed. These are the tensor veli palatini, levator veli palatini, palatopharyngeus, palatoglossus, musculus uvulae, superior pharyngeal constrictor, and salpingopharyngeus. These muscles contribute to either a palatal or a pharyngeal component of velopharyngeal closure. This information should guide further research into targeted methods of assessment, management, and treatment of VPI in wind musicians.

Increased Exhaled Nitric Oxide in Wind and Brass Musicians

Playing a wind or brass (W/B) instrument is considered a strenuous activity for the respiratory system. Exhaled nitric oxide (FeNO) is a potential marker of airway inflammation, and the aim of this study was to compare levels of FeNO between W/B musicians to a group of people who did not play these instruments. Eighty-three (41 male) nonsmoking, nonasthmatic subjects, aged between 18 and 60 years, participated in the study. Forty-one played a W/B instrument, and 42 either played a non–wind/ brass (NW/B) instrument or no instrument at all. Subjects completed a respiratory health questionnaire, height and weight mea- surements, skin prick tests (SPTs), and FeNO measurements. FeNO levels were increased in W/B musicians compared to NW/B subjects (23.6 ppb and 18.1 ppb, respectively). After adjusting for age, sex, height, and degree of atopy, this difference approached statistical significance (P 1⁄4 .06). Increased FeNO may indicate subclinical airway inflammation in W/B musicians.

Bagpiper's Hernia

A 65-year-old bagpiper developed onset of inguinal hernia symptoms while playing his instrument. The patient, a nonsmoker and retired from an occupation that involved no heavy lifting, had been an active piper and performer for 10 yrs. He underwent a right inguinal herniorrhaphy with placement of a mesh implant, with full recovery. The etiology of inguinal hernias and their occurrence in wind musicians are discussed. While there are few reports in the medical literature, many anecdotal descriptions of the problem among musicians can be found.

Trigeminal Neuralgia in Wind Musicians

The author reports 3 patients with trigeminal neuralgia whose pain was triggered by musical performance. Use of the muscles of embouchure activated the trigger zone when playing the clarinet, saxophone, flute, piccolo, trombone, or whistling. In each case, the location of the trigger zone was perioral, regardless of which division of the trigeminal nerve emanated pain. Trigeminal neuralgia is a particularly disabling affliction when it occurs in wind musicians.

Increased intraocular pressure and visual field defects in high resistance wind instrument players

ObjectiveIn this twofold study, part 1 aimed to determine whether the playing of high resistance wind instruments elevates intraocular pressure (IOP) and if so, to investigate the mechanism of IOP elevation and whether its magnitude differs while playing high resistance versus low resistance instruments. The purpose of part 2 was to evaluate whether high resistance players have a greater incidence of glaucomatous changes than other musicians. DesignThree case reports and a cross-sectional study. ParticipantsTwo players of high resistance instruments and one player of high and low resistance wind instruments participated in part 1 of the study. Nine high resistance wind players, 12 low resistance wind players, and 24 nonwind players were recruited among professional musicians in the Boston area to participate in part 2. InterventionIn part 1, IOP and uveal thickness changes were measured by pneumatonometry and ultrasound biomicroscopy in two participants playing their high resistance wind instruments (trumpet and oboe) and in a third participant playing both high (trumpet) and low (clarinet and saxaphone) resistance instruments. Each musician in part 2 underwent medical and musical history, measurement of IOP, Humphrey visual field testing, slit-lamp examination, gonioscopy, and dilated examination. Main outcome measuresIntraocular pressure and uveal thickness changes, and visual field loss and optic nerve head appearance were the main parameters measured in part 1 and part 2, respectively. ResultsIn part 1, pneumatonometry showed IOP elevation dependent on the force of blowing, and ultrasound biomicroscopy revealed uveal thickening associated with IOP elevation. The magnitude of IOP elevation was dependent on the amount of expiratory resistance provided by the particular instrument. Part 2 showed that life hours of high resistance wind instrument playing had a significant relationship to abnormal visual field (P = 0.03) and corrected pattern standard deviation (CPSD) scores (P = 0.007) in univariate logistic regression and univariate linear regression, respectively. A 0.011-unit increase in CPSD for each 1000 life hours of high resistance wind playing was found. ConclusionsHigh and low resistance wind musicians experience a transient rise in their IOP while playing their instruments as a result least in part of uveal engorgement. The magnitude of IOP increase is greater in high resistance wind players versus low resistance wind players. High resistance wind musicians had a small but significantly greater incidence of visual field loss (abnormal fields and increased CPSD scores) than other musicians, which was related to life hours of playing. The cumulative effects of long-term intermittent IOP elevation during high resistance wind instrument playing may result in glaucomatous damage, which could be misdiagnosed as normal-tension glaucoma.

Laryngeal movements during wind instruments play

Historically, the concern of wind instrumentalists has been diaphragm control and embouchure. Laryngeal movement during "blow" has been overlooked or neglected by wind musicians. It has been said that musical tone has to be produced by the resonances of the player's air column by opening his larynx during blow. In the present study, fiberscopic observations of the larynx during blow revealed that musical tones were played with adducted vocal cords. Narrowed glottis appeared to control the airflow of the blow. Persons who could not make musical tone blew with open glottis. Vibrato was also made by rhythmic open and narrowing movements of the glottis. The authors concluded that the larynx regulates the airflow of the "blow". The authors postulated that the embouchure might be important as the receptor of the airflow rather than controlling the movement for "blow".

Dental care habits, oral hygiene, and gingival health in Swedish professional musicians.

The investigation covered 250 professional musicians employed in 3 leading national orchestras in Stockholm, Sweden. The aims were to describe dental care habits, such as frequency of dental visits and frequency and methods of oral hygiene, and to relate these habits to oral cleanliness and gingival health in wind and non-wind instrument musicians. The results showed that 81.2% visited their dentist at least once a year and that 82.8% had had such a regular habit for the past 5 years or more. All subjects claimed to brush their teeth daily, and 66.0% used supplementary oral hygiene aids. The clinical examination showed that oral cleanliness and gingival health were of good standard. Mean plaque index was 0.9 and mean gingival index 1.2. Both measures increased with age and were closely correlated (r = 0.80). The relationships between the dental care habits studied and the clinical conditions with regard to oral cleanliness or gingival health were rather weak, although trends towards better gingival condition and oral cleanliness were observed with increasing frequency of toothbrushing. The results indicate a high degree of dental conscientiousness in professional musicians. No differences were observed between wind and non-wind instrument musicians.