[Dixielandjazz] Embouchere Dystonia

[Steve Barbone]

Bill Sharp asked about the embouchure type of focal dystonia. Several people
I have worked with developed it. None has conquered it. However, several
trombone players have switched to clarinet with some success. They are
mainly in the teaching end of the music business.

And in the hand type of focal dystonia, pianists have switched to violin and
vice versa with some success. Or right handed violinists have switched to a
left handed approach. It takes a while to accomplish.

Focal Dystonia has affected thousands of musicians. Below from the Dystonia
Medical Research Foundation. Surf their site for complete information.

http://www.dystonia-foundation.org/

Cheers,
Steve Barbone

"Embouchure" Dystonia

What is it?
Embouchure dystonia is a term used to describe a type of dystonia that
affects brass and woodwind players. The term embouchure refers to the
adjustment of the mouth to fit the mouthpiece of a wind instrument. The
anatomy of this form of dystonia includes muscles of the mouth, face, jaw,
and tongue.  

Symptoms
The abnormal movements that characterize embouchure dystonia are often very
subtle and occur only while the musicians is playing or buzzing into the
mouthpiece. Most brass players use a combination of puckering and smiling to
play. At least twelve muscles are involved in positioning the mouth in this
way, not including the equally complicated structure of the tongue and jaw.
Pinpointing the most important muscles necessary for shaping the mouth to
play a brass or woodwind instrument is difficult.

Symptoms of embouchure dystonia may include:

*    Air leaks at the corners of the mouth:
*    Sometimes worse in higher registers and accompanied by a noticeable
     tremor. 
*    Involuntary, abnormal contractions of the muscles in the face:
*    Involuntary puckering;
*    Excessive elevation of the corners of the mouth;
*    Involuntary closing of the mouth.

Some musicians' difficulties are limited to sustained notes in particular
registers or to certain passages at specific speeds. The dystonia is
typically painless but may elicit intense psychological stress.

If embouchure dystonia causes any type of impairment, it is because muscle
contractions interfere with normal function. Features such as cognition,
strength, and the senses, including vision and hearing, are normal. While
dystonia is not fatal, it is a chronic disorder and prognosis is difficult
to predict. 

Cause
Embouchure is believed to be due to abnormal functioning of the basal
ganglia, which are deep brain structures involved with the control of
movement. The basal ganglia assists in initiating and regulating movement.
What goes wrong in the basal ganglia is still unknown. An imbalance of
dopamine, a neurotransmitter in the basal ganglia, may underlie several
different forms of dystonia, but much more research needs to be done for a
better understanding of the brain mechanisms involved with dystonia.

Diagnosis
Musicians may perceive the early symptoms of dystonia as the result of
faulty technique or lack of sufficient preparation. Therefore, many
musicians intensify rehearsal and practice sessions and do not seek medical
help until the condition is quite pronounced.

Diagnosis of embouchure dystonia is based on information from the affected
individual and the physical and neurological examination. At this time,
there is no test to confirm diagnosis of embouchure dystonia, and, in most
cases, laboratory tests are normal.

Treatment
Treatment for dystonia is designed to help lessen the symptoms of spasms,
pain, and disturbed postures and functions. Most therapies are symptomatic,
attempting to cover up or release the dystonic spasms. No single strategy
will be appropriate for every case.

The goal of any treatment is to achieve the greatest benefits while
incurring the fewest risks. It is to allow you to lead a fuller, more
productive life by reducing the effects of dystonia. Establishing a
satisfactory regimen requires patience on the part of both the affected
individual and the physician.

Oral medications, including Artane (trihexyphenidyl), Klonopin (clonazepam),
and Lioresal (baclofen), are often used to treat segmental and generalized
dystonias and may offer some relief for focal dystonias. Botulinum toxin is
an option, but the anatomy of the area must be carefully considered to avoid
unacceptable oral weakness.

Support
By educating yourself with information, you have taken the first step in
dealing with dystonia. Dystonia and its emotional offshoots that affect
every aspect of a person's life - how we think, the way we act, and how we
cope. 

Stress is an inevitable part of life, and although it clearly does not cause
dystonia, it can aggravate dystonia symptoms.

Like anyone whose life and career are affected by dystonia, musicians may
feel the impact of the disorder at a very deep level. A decreased ability to
perform may strike at the very core of a musician's livelihood and
personality. 

Often, treating depression can result in an improvement of dystonia. It is
important to remember that depression is treatable.

To help address these needs, Musicians with Dystonia, a program entity of
the Dystonia Medical Research Foundation, was founded in 2000 by
professional French Horn player Glen Estrin and Steven Frucht, M.D., a
neurologist at Columbia-Presbyterian Medical Center in New York, NY. The
group is dedicated to serving the special needs of musicians affected by
task-specific focal dystonia, particularly hand and embouchure dystonias.
Musicians with Dystonia is a group of individuals committed to dystonia
awareness, education, and research on behalf of both individual musicians
and the greater dystonia community.