Sunday, October 23, 2016

October: Monthly Shared Articles

First article is titled: "What DOES it take to be a Professional Orchestra Musician?" 
This blog post also points out something that is a significantly huge part of preparing for focal dystonia rehabilitation! Changing your mindset from a performance technique mindset to an exploratory mindset full of love, creativity, and adaptability. 

Everything taught to you haas to go out the window. Foget it all (i.e. all knowledge and practice of technique, embouchure formation, setup, proper breathing...). Literally have to deprogram everything so you can start over and start physical rehabilitation from a healthy mental place. Not easy because musicians instruments and reputation are woven tightly into their identity.

What a great article! If you're like others who lean more towards this side, do whatever it takes to regain even a little ownership of your own voice/sound and expression in music. This is why guitar has always been my secondary instrument. It allowed me to feel creative and free of many limitations at times, or when demands got tough. 

A glimpse at part of the article:
 "We get similar effects in blind people who read Braille with several fingers at once: they develop a single representation of all these fingers on the somatosensory cortex, but are not able to determine which part of the information received in the brain comes from which finger. Psychologist Thomas Elbert further points out a parallel of this in all of us: our toes are generally stimulated only simultaneously as we walk, and most of us have trouble telling which of the middle toes has been touched upon application of a light pressure stimulus. Indeed, our toes are not individually represented on the somatosensory cortex as our fingers are."

"Dr Merzenich of the University of California San Francisco calls focal dystonia of the hand a “learning-based catastrophe” and a “failure of the brain’s learning processes”. Consequently, he focuses on developing techniques that will help to “re-normalize the learning system”, in helping to newly distinguish the areas on the somatosensory cortex that have become blurred. Although this approach is very new, Merzenich claims some good results in training children with linguistic impairments, such as dyslexia, which show similar blurring of representations in the brain."

Friday, October 7, 2016

More Alternative Medicine/Therapies (Part 3): Body Movement Awareness Methods (Somatics), Modifications, and Musical Exercises for Focal Embouchure Dystonia

(PART 3) External Modifications to Playing

A couple of external modifications have helped me with my dystonia. As I progressed the modifications changed over time. Here are some examples...
  • Playing with the bell on the leg or off the leg...
    As a horn player (pre-embouchure dystonia) I had always played off my leg. But with embouchure dystonia, it was the complete opposite. I started rehabilitating on my mouthpiece only, and later on in the processes moved onto my horn and found that playing on my leg made things significantly easier. It was as if I had more control and my embouchure didn't have to adjust to any slight external movement that I would have had to deal with if I played off the leg. As I improved over time and regained more abilities, I found that switching back and forth between playing on the leg and off the leg was both helpful, but it just depended on the way my embouchure was feeling that day. With embouchure dystonia, you're highly sensitive to what helps you and what doesn't (even if it is just the slightest tiniest modification).

    When I started playing on the leg, it formed a type of  crutch for me. That's what all these external modifications are...everything is a crutch (i.e. something you rely on or lean on for support) in the beginning of rehabilitation. As I regained more control of my embouchure, I didn't need the crutch as often, so I started switching back and forth between playing on the leg and off the leg depending on how my embouchure felt. Some days it felt easier to play off the leg, and other days I couldn't play at all unless I balanced my horn on my leg.
  • Using a mouthpiece with a good amount of back-pressure...
    When I first started rehabilitating, I didn't even play my horn. I focused on mouthpiece buzzing ONLY for several months, maybe even a year? and NO tonguing, and NO breath control. In one of my previous posts I wrote about how I basically had to deprogram that feeling of automatic "playing-mode" because once my body was aware that I was physically playing, it completely tensed up or locked up. Therefore, I had to forget about everything and just focus on breathing out normally (without thinking about it and without preparing my lungs through breathing exercises...just let it all go!), and also focusing on just buzzing through very loose lips, even if it meant frowning or scrunching the chin...just playing with the flabbiest most loose lips possible. But sometimes my muscles needed to stretch and I started doing stretches, because sometimes I had to give into the tension I felt and just squeeze my facial muscles into contorted expressions just to relieve the tension...kind of like trying to get rid of a huge muscle cramp. So later on I realized how important it was to do facial muscle stretches first, and then focus on flabby lips in buzzing.

    About needing a mouthpiece with back-pressure. It was necessary for me to play on a mouthpiece that provided a little more resistance than normal, because again, it provided a crutch for me. It was much easier for me to buzz and get a sound out. I had less spasms and more control. It may have not been that much more control given, but it was significantly noticeably more efficient than playing on a free-blowing mouthpiece.

    Lucinda Lewis does something very similar called blocked-buzzing. This is the best analogy I can think of to describe why the resistance or back-pressure is necessary in rehabilitation. She said that one day when blowing into a soda bottle and looking into a mirror, she realized that because the air wasn't being allowed out of the bottle, it resulted in air resistance against the lips. This air resistance made her embouchure muscles form into a natural embouchure because there was no room for the muscles to relax, they had to fight the air resistance.

    It's like jumping on a trampoline. If you are jumping on flat ground, your leg muscles have to carry a lot of your weight, and it takes a great deal more muscle strength to jump on flat ground and it's a lot harder on your joints. But if you are on a trampoline, you are still using your leg muscles to bounce in the air, but it is significantly easier because the trampoline-springs provide that extra back-pressure or support. You push your legs against the trampoline mat and it pushes back, and it's the trampoline's resistance that shoots you off into the air. It's the same with mouthpiece back-pressure! You push up against the resistance and it helps by pushing back, and it's as if your embouchure muscles don't have to try that hard to function.

    This only works in the case of embouchure dystonia, because of course if you don't have embouchure dystonia then more back-pressure or resistance just gets in the way. You feel the opposite; like you're trudging through mud and having to work harder to play higher and louder because there is no flexibility. But with embouchure dystonia, we are just focused on trying to hold onto a note without our muscles giving out, spasming, or fighting back. So the back-pressure of the mouthpiece helps us hold on to the note(s) for a split second.

    Later on when I didn't need my heavy back-pressured mouthpiece as much, I kept switching back and forth between one that was less resistant and the one that was more resistant. It's like learning how to walk again. Sometimes you get to a point where you don't always need a crutch to walk, but sometimes you do! Some days you feel great, and other days you fall back on your crutches because you're exhausted or the stamina just isn't there from working so hard.

    Eventually I reached a point where I felt my muscles actually start to work or that feeling of "kicking in". If that makes sense? I started to see my muscles try to form a stable embouchure without me even trying. It was never forced. But when it did happen, it grabbed my attention.
  • Using your right hand to hold your mouthpiece and closer to your mouth when buzzing...
    As a horn player I'm so use to holding my left hand up when I play, that actually buzzing with the mouthpiece in my right hand helped me lessen that "automatic horn-playing mode" that I was working so hard to get out of my body. In a way it is kind of like a sensory trick (neurologist use sensory tricks to help trick the brain into thinking that it is doing something different). It may not seem like it makes a huge difference at first, but over time I found that buzzing out of my right hand helped lessen my spasms.

    Also holding the mouthpiece around the cup or closer to the rim with my fingers/hand allowed me to have more control. Usually we are taught by our teachers to hold the mouthpiece with only two fingers near the end of the shank so that way we use more of our embouchure muscles and air to control the buzz, rather than relying on pressure. But with dystonia, the opposite is necessary....we need to help our embouchure out by holding the mouthpiece in a secure way. If we try to buzz while the mouthpiece is loosely set upon our lips, it's a million times harder/worse and brings out the spasms and dystonia symptoms even more. At least this was the case for me! So I absolutely had to do whatever was most comfortable for me and allowed me to work with my dystonia symptoms....none of the traditional methods of playing or pedagogy could help me...I really had to completely ignore or unlearn every so called "good" habit ingrained, and instead had to trust my body and allow it to tell me what to do. I had to be highly in tune with my dystonia symptoms and how they functioned.

    Again, as I improved, the less I needed the sensory tricks and crutches to help me play. But these steps were absolutely necessary for my recovery when my dystonia symptoms were at their worst.
    ....same goes for when transferring over to your horn. Try playing your horn with the right hand, and no use of tongue! 
  • Playing Stop-Muted
    Playing with a straight mute or practice mute in the bell made my symptoms worse. But stop-muting the bell with my hand actually helped. I don't know why the sensation of the stop-muting helped, but I believe it helped physically and also with my sound. I always sounded much better stop-muted, so I practiced this way about half-way through the second year of retraining.
  • Playing With or Without a Mirror
    Before I was diagnosed, I was constantly looking in the mirror at my embouchure when I practiced because it looked as if all of my muscles were melting or becoming distorted. I became too obsessed with trying to correct my dysfunctional embouchure at first; by trying to flatten my chin and straighten my corners, but nothing was working.
    So throughout the first part of retraining after diagnosis, I had to focus more on feeling things, rather than looking at my embouchure in the mirror. However, I eventually did need the mirror, because it did help me become more aware of what my symptoms were; I could see where every little twitch/spasm occurred and on which note. I could see when the left side of my lower lip started to droop, etc.
    It was important to use a mirror, but in moderation, and only when I became less analytical about trying to "fix" my embouchure. It wasn't until I started to focus more on "feel" that I could start using the mirror more often to observe my symptoms.
  • Playing other instruments
    At first this didn't help me. Actually it didn't help for quite a few years. But after regaining some abilities. playing other instruments started to help. They helped condition my muscles in a different area or way, and this allowed me to transfer those adapted muscles and use to my horn playing.
  • Changing Mouthpiece Angle
    Constantly changing my mouthpiece angle to find a more comfortable position helped greatly. Even though the angle and position of my mouthpiece changed almost every 2 minutes or every day, it still helped to experiment and seek out a spot on my lips and angle that helped me regain more of a grasp on my notes.
  • Sensory Work
    This should actually be logged under body-movement methods, because it deals more with retraining your sensation  - sensory tricks or body mapping.

    Practicing using non-focused air is key! If you can get either a small windmill to blow on, or a feather, this will help. Practice blowing with loose, wide, and unfocused air coming out of your lips. Think of the type of air you huff and puff when angry....if your lips and your cheek/facial muscles are truly loose, then you should feel the air fill up both cheeks a little, or the air will fill up and puff out near the corners of your lips, or even lower near your chin.

    Practice putting things up to your lips; like a spoon touching the surface of your lips, or practice blowing through a really wide straw (like the ones that they give you for bubble tea). It sounds silly, but it's a way of desensitizing your body and brain from constant "mouthpiece/automatic horn playing mode." When your brain realizes that not everything you put up to your lips is a horn, it helps. Because that's basically what it is doing. I had so many problems with drinking from a water bottle or even a coffee cup with a cap on it, just because my spasms would kick in as if I were playing the horn.

    Holding bubbles of air in my cheeks and mouth helped a lot to (just don't fill them up too much because it can actually open or damage a gland in your cheek, so be careful). 
There weren't too many external modifications, but the ones that I listed helped me. The exercises that I will write about next are what helped me tame my dystonia symptoms the most.

First Orchestra Concert in Six Years!

I had the honor of performing with the Longmont Symphony Orchestra in Colorado this last weekend. I took a risk and said yes to subbing for the 4th horn player, thinking that it would be doable with a couple easy pieces and one large more difficult piece.

But boy was I wrong about the programming! The concert included Pines of Rome, Enigma Variations, Daphnis & Chloe, and Strauss's Four Last Songs. There was transpositions in bass clef and old notation in some of the pieces and a tiny solo for 4th horn.

I had never been much of a low horn player, even before dystonia, I primarily held principal positions. It was too late to turn back now. Plus I had worked so hard and looked forward to such an opportunity for so long! I decided to prepare for it and hope for the best come rehearsal time. We only got two rehearsals and then the concert.

I was surprised that things went so well! I was so nervous about my dystonia kicking in during the long stretches of held notes throughout all of Strauss. I was scared that either spasms would violently through me off the notes (i.e. ending them abruptly), or I wouldn't have enough grasp on the notes to adjust my intonation if needed to (combined with using my right hand in the bell). But all the pieces turned out to be totally doable thanks to my mouthpiece that made things so much more comfortable.

I have been playing trumpet on a daily basis with my students. I have one class of literally 10 beginner trumpet players this year. For over a year now I've been having to play so many different instruments due to teaching; mainly flute, clarinet, oboe, trumpet, and trombone. On all of them I started out shaky, but my dystonia symptoms have receded a great deal over the year.

Trumpet is the one instrument I've spent the most amount of time playing. My dystonia symptoms are actually significantly less severe on trumpet than any of the other brass instruments. Luckily I own a french horn mouthpiece designed by a trumpet player (you can totally tell if you ever get the chance to look at it) and it looks like a trumpet mouthpiece almost. The rim is contoured like a trumpets, the body is funnel-shaped, but then it is a heavy and thick/dense mouthpiece. Probably as heavy as a trombone mouthpiece.

The feeling of the trumpet rim (it's A LOT of RIM!) on a horn mouthpiece has done a bit of sensory trick for me and my symptoms don't kick in as often. I can't play very much in the high range, but that's due to the mouthpiece and it's rim contour and thickness. However, my notes are stable.

Enough about my mouthpiece! Here are some photos from my first rehearsal. Both rehearsals and the concert went smoothly. I definitely needed that feeling of playing in an orchestra again. It was way over due. I took a risk because I knew I could do it, even if it took a lot of physical effort. I was very proud of how much progress I've made and that I'm able to perform even the slightest bit or every blue moon again. There have been so many days, months, and years missing playing with an orchestra, so even having the chance to relive it once again, just once, is a dream come true!

Thursday, October 6, 2016

October Link of Interest: Observing Dystonia Blog by Andrée Martin

Andrée Martin,
flute professor at Columbus State University, writes a blog called Observing Dystonia and documents her FTSHD (Focal Task-Specific Hand Dystonia) retraining. Recently Andree posted a blog I found interesting on progress through the use of dowels, which I posted below. She is actually trained in Alexander Technique and Feldenkrais ( which both dwell in body-mapping techniques.

This was such a great read, and I'm very happy to see a professional musician sharing their journey through recovery!!! It gives many hope and comfort knowing they are not alone throughout their own obstacles in overcoming this disorder. Thank you Andree!

Friday, September 16, 2016

Saturday, August 27, 2016

Phil Smith Speaks About Focal Embouchure Dystonia

I've noticed lately a lot of people find my blog by searching for information about whether or not Phil Smith has dystonia. I know this because my blogger stats tell me keywords that people type in search engines that lead them to my blog. I found myself curious whether he has FTSED or not, but was hoping that he didn't.

As many of you know, my twin sister is a trumpet player. I can still remember in 4th grade she had a old cassette recording of Phil Smith that came with a book of duets that she could play along with to the recording. Around 2006(???) our trumpet friend Andrew Grushkin was studying at NEC at the time with Tom Rolfs and mentioned he would see Phil at a masterclass. So Ally (my sister) sent him the duet music that she started learning trumpet on...she wanted to get his autograph. Well apparently the photo on the front cover was dated because Phil said, "Wow. I haven't seen that in a while." He's always been her trumpet god, along with Maurice Murphy who sadly passed away not too long ago. I myself saw Phil give a masterclass in 2010 during my last year of undergraduate studies at the University of Northern Iowa. Anywhoo, my point of all of this is that he's made such a huge impact on a lot of people, and he has tremendous faith too (I know that it gives him strength, as it has to me during my first stages of dealing with it), and it's hard to see someone this magnificent and miraculous facing this disorder.

A couple weeks ago my brother-in-law (my twin sister's husband...also a trumpet player!) sent me this Phil Smith masterclass youtube video (was recorded at the University of Columbia):

He said that Phil Smith speaks a little bit about his recent embouchure dystonia diagnosis. If you watch at 14:43, and also at the end of the video. It was very moving watching him speak about it. I'm glad that he's working on rehabilitating with Jan Kagarice, because she really is the best of the best. Hoping for him to be able to overcome it and wishing him all the best. This great man deserves so much praise and support for the work he's done.

Monthly Research Article: A Video Guide to Diagnosis and Evaluation of Embouchure Dystonia by Dr. Frucht

Sorry I haven't had time to post recently! I've been busy with summer camp ending and starting another school year. I will post more soon. I'm going in for botox injections in my masseter muscle and frontalis this coming month. Wish me luck, because it's the first time I'll be trying botox...not only for my dystonia, but for TMJ. I'm going to see if I can get permission to take photos or record it so I can post it on here. I am also hoping that my research clinic calls soon to fly me in for the upcoming study. It's been delayed but I'm looking forward to whenever it comes time for me to participate. Here's this months article! Check it out....