FLETCHER, SETH DAVID, D.M.A. The Effect of Focal
Task-Specific Embouchure Dystonia upon Brass Musicians: A Literature
Review and Case Study. (2008) Directed by Dr. Dennis AsKew, 173 pp.
To promote awareness and understanding among brass musicians of focal
task-specific embouchure dystonia (FTSED)—a misunderstood and
debilitating occupational disorder—a comprehensive review of literature
from prominent medical, scientific, and musical sources was undertaken
to determine the definition, causes, and treatment of the condition. A
case study was also included with the intention of providing a source
for reference and exploring possible pedagogical influences on FTSED.
FTSED can be defined as a neurologically-based movement disorder
characterized by abnormal random or sustained involuntary muscle
contractions, initiated during playing, that cause embouchure
dysfunction. A muscle spasm that occurs in a trumpet player’s lips when
attempting to start a note, a horn player’s inability to sustain a tone
without a rapidly shaking embouchure, or a tubist’s jaw inexplicably
clamping shut when attempting to play octave leaps are all examples of
FTSED.Chapter One contains a brief introduction and definition of
FTSED, a discussion of embouchure terminology and function, and an
overview of key neurological concepts. Chapter Two includes further
investigation of the definition of FTSED, with consideration of the
causes, symptoms, diagnosis, and treatment of the disorder. Chapter
Three presents summations of empirical studies of FTSED and similar
dystonias, while Chapter Four presents summations of case studies of
musicians with focal dystonia. The final chapter includes a summary of
key points, suggestions for future research, and guidelines for
recovery. A case study of FTSED is contained in the appendix, including
specific details of the initial appearance and progression of symptoms,
pre-diagnosis symptom management strategies, a week-long intensive
re-training program, and subsequent methods and routines leading to a
return to public performance.
The exact causes of FTSED are unknown and current treatment options
provide only minimal benefits. Often career-ending, FTSED has no known
cure and medical research and insight with regard to the disorder are
limited. Additionally, trends in brass pedagogy may contribute to the
development of embouchure dystonia. Despite the minimal reports of
successful long-term outcomes in clinical studies, recent findings
indicate that FTSED may, in fact, be treatable and preventable, yet
research must be undertaken to test such assertions. Improving the
prognosis for FTSED and facilitating rehabilitation necessitates
increased awareness among performers and teachers, a re-thinking of
brass pedagogy, and the development and testing of effective treatment
programs.
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