2/3/2017. Discuss findings of latest research of psychoneur0 immunology

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1 Jan Idzikowski, PA C Discuss findings of latest research of psychoneur0 immunology of music Introduce the concept of the athletic musician Outline types of injuries musicians sustain Discuss prevention strategies Noise Induced Hearing Loss what? Performance Anxiety 1

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4 Improves overall memory, especially verbal memory Improves math and reading skills Increases literacy Higher scores on all standardized tests Improves visual spatial processing Multi sensory/motor experience, stimulates auditory motor networks Canadian Study 2006 Mapping sounds to actions > music as therapy for Neurological disorders; stroke, autism, Parkinson's, stuttering Alzheimer's Disease Pain Management Crisis, Trauma recovery Stress and Anxiety 4

5 Elena Mannes Do you consider musicians to be athletes?? Athletes and musicians share similar physical and mental demands; acquire skills through long hours of practice, performing feats of great dexterity, strength and stamina. 5

6 Like athletes, musicians are prone to numerous neurologic and musculo skeletal conditions. 1988, survey of musicians attending the ICSOM showed that, in the previous year, 76% of performing musicians reported at least one medical problem that was severe in terms of its affect on performance. Similar incidence seen college level performers, as well as in high school AND middle school musicians! Middlestadt et al. Prevalence of Severe Musculoskeletal and Nonmusculoskeletal Problems by Instrument Group and by Gender in ICSOM Musicians (n=1378) Instrument Group (%) Gender (%) Overall Strings Wood Brass Other Male Female Musculoskeletal Nonmusculoskeletal Severe Prevalence of Problems in ICSOM Musicians (n=2212) % Present % Severe Musculoskeltal Finger (R/L) 9/16 5/9 Hand (R/L) 9/14 5/10 Wrist/forearm (R/L) 17/17 9/10 Elbow (R/L) 10/8 6/4 Shoulder (R/L) 20/20 13/11 Neck Upper Back Middle Back Low Back Nonmusculoskeltal Acute Anxiety 13 8 Depression 17 7 Ear Embouchure 17 6 Eye 20 9 Headache 10 5 Stage Fright

7 Growing recognition and awareness that musicians and athletes share many physical demands and personality traits and injuries. Corresponding growth in research and professional organizations on unique problems in the performing artist artsmed.org Athletesandthearts.com Overuse Conditions 1) Tendonitis 2) Tenosynovitis 3) Sprains and Strains 4) Myofascial Dysfunction Nerve Conditions 1) Carpal Tunnel Syndrome (Wrist) 2) Cubital Tunnel Syndrome (Elbow) 3) Focal Dystonia; can be career ending Conditions of Aging Non music related Injuries 7

8 Focal Dystonia Instrument Time spent playing Sudden increases in playing time Repertoire Playing technique Change of teacher (Conductor/Teacher) Playing conditions Practice technique Talent Conditioning General Health Posture Individual factors (hand size, body proportions) Stress Gender Joint Laxity Bad Luck ;( Enhanced physical and aerobic fitness; strength (extremities and core), endurance Flexibility; stretching yoga pilates Properly fit/adapted instrument Position awareness; tension relaxation Alexander Technique Practice techniques; warm up, breaks, vary repertoire, Motor Imagery 8

9 Warm up Breaks Posture, playing position Technique Repetition Pacing Straps Stands Shoulder/Chin rests Flute Mouthpiece Shapes Rest; relative, absolute, very gradual return Evaluate technique Medications PT/OT Modify performer instrument interface Relaxation Body Awareness Injections Splints Surgery? 9

10 Body Mapping Alexander Technique Andover feldenkrais Biofeedback 50% of musicians may have problems with hearing loss. Listening to music, live or recorded, in performance or rehearsal, can result in significant exposure to high sound levels. Risk of injury is based on a combination of sound intensity and duration. Noise exposure is cumulative: all sources (24/7) of elevated sound levels contribute. Permanent noise induced hearing loss is irreversible. Temporary noise induced hearing loss is reversible with adequate rest and recovery. 10

11 Hearing loss is a function of intensity and duration Maximum weekly exposure 85 db x 40 hrs/wk Some examples: Trumpet db Alarm clock 80 db Violin db Lawn Mower 90 db French Horn 107 db max Snowmobile 100 db Rock Guitar >115 db max Amplified Sound db max ipod % college freshmen in music programs have significant hearing loss, 50% by end of second year. Permanent Hearing loss leads to: L f Pi h P i Recommended Maximum Daily Exposure of Continuous Noise Decibel Level NIOSH OSHA 85 8 hours 16 hours 88 4 hours 10.6 hours 91 2 hours 7 hours 94 1 hour 4.6 hours minutes 3 hours minutes 2 hours minutes 30 minutes 120 (close range) immediate immediate Manage your exposure; dosimeter 11

12 Turn Down the VOLUME! 3 db less=1/2 exposure. Wear ear plugs Not all ear plugs are alike Paul Stanley Kiss Neil Young Ozzy Osbourne Phil Collins George Martin Will. i. Am Brian Wilson Jeff Beck Eric Clapton Peter Townsend Stephan Stills Barbara Streisand Chris Martin Foxy Brown Beethoven Evelyn Glennie 12

13 it is felt by all who dare to assert themselves before their fellows Gabbard % experience symptoms; Females > Males many avoid performing because of severity; many with symptoms AND perform feel quality of their performance adversely affected experience of persisting, distressful apprehension about, and/or actual impairment of, performance skills in a public context, to a degree unwarranted given individual aptitude, training and level of preparation Kenny 2008 Biologic how we are wired Developmental childhood/adolescent experiences Cognitive awareness/interpretation Behavioral how we outwardly respond 13

14 Physical: Heart rate/respiration rate, nausea, sweating Cognitive: Loss of concentration, memory failure, misreading Behavioral: Poorer technique, postures, tremors/trembling Cognitive distortions lead to maladaptive behaviors Catastrophic thinking Post performance rumination Unrealistic goal setting Extreme perfectionism Inability to take pleasure or comfort in positive aspects of performance Avoidance, drug/alcohol abuse Normal apprehension Adaptive Debilitating apprehension Maladaptive Yerkes Dodson Law Too Little or Too Much = Too Bad Motor Performance None A lot Anxiety Arousal 14

15 Breathing drives the anxiety response Controlled breathing exercises Anxiety causes increased muscle tension Meditation/relaxation/Alexander techniques Fear of unknown causes anxiety Progressive exposure to performance opportunities Medication; beta blocker, slows heart rate, respiration Much more serious condition that can end performance careers. Requires prolonged progressive Cognitive Behavioral therapy Acceptance Commitment Therapy Awaken Annie The Driven ANY QUESTIONS??? 15