Focal Dystonia : Reprogramming your Satnav

Brass players, including those at the top of their professional tree, have experienced Focal Dystonia that has either permanently, or temporarily, halted playing. Marcus Reynolds was a ‘pro’ player who overcame the challenge and here offers his personal (as opposed to medical) perspective on the road to recovery.

“I was inspired to write this for several reasons, not the least of which was an accident when I fell from a stage, which badly damaged my lip. My resultant anxiety about how I was going to play again and continue to make a living led to my own experience of Focal Dystonia (FD). I have learned to play again and it has been a struggle, but I have learned much about FD and embouchure problems along the way, which I’d like to share that with other brass players and teachers.

Dystonia is uncontrollable muscle spasms caused by faulty signals from the brain. Focal refers to a condition affecting a precise area of the body, such as the lips and muscles supporting the embouchure. Experiencing FD is a bit like dealing with a sat-nav that can’t understand that your route is blocked. Progress cannot be made, frustration mounts, only aggravating the situation. The sat-nav may even need to be turned off and the driver resort to basics (eyes and a map!). Similarly, the FD sufferer returns to basics, or in medical terms the brain’s cortical map needs untangling.

When a brass player visits me with FD, the first thing I aim to do is to change the name of the condition. For some, the mere mention of FD can amplify the associated problems, even triggering involuntary muscle movements, so I try to use a different terminology when discussing their playing. Typically, an FD sufferer is unable to control the lips as needed, so often I start sessions with certain facial exercises, which look like gurning, followed by some gentle buzzing using the Stratos embouchure training aid that I have developed. I set Stratos so the lips are hardly touching the mouthpiece. In that position, the brain does not register an instrument is being played. This avoids full contact on the lips, which would allow the brain to associate the problem with the instrument, thus triggering a rejection of it. Playing with some of the usual weight on the lips removed is difficult at first, but it cheats the brain to the extent that the student does not produce and hear the heavily debilitating ‘bu bu bu’ sound generally associated with the symptoms of FD. After a few repetitions of this exercise, clearer notes appear, almost like magic.

This rehabilitation is about re-routing the cortical map and, to achieve this, I have created a series of mind and muscle distracting exercises. A main aim is to build a new embouchure and the unpolished sounds that the instrument might emit are part of the process of recovery. A beginner’s early, unfocused sounds are similar to those made by an FD sufferer, but I believe that FD sufferers should be treated almost like beginners who often take time to achieve a really nice sound, but do not shun or reject the instrument because they have no ‘history’ to compare a better sound to. Experienced players, however, appreciate a good sound, so are frustrated when they cannot produce it.

Even when a smooth, even-toned note is being produced, FD can suddenly trigger an involuntary spasm resulting in a high-pitched squeak. However, as there will often have been a good quality note before the problem arises, I try to get the player to produce notes in semi-tones, either side of the targeted good note.

Repeating this extensively can achieve a new stability, controlled by a new muscle memory, triggering new synapse messages to the brain. Recovery is partly about breaking what we might call ‘historic spasms’ – that is spasms arising from old ways of playing. For valve instruments, this can be tackled by using different fingering, so in the case of a valve instrument, I get my student to play a scale of C. Then, as we ascend from low C (after pre-pitching an E top space, also thinking downwards and cerebrally pitching, as if you were whistling), I get the G played in 1st and 3rd, the A in 3rd, the B in 1st and 3rd, and the remaining C in 2nd and 3rd. This way, the instrument is raising the pitch and not the lips. Before starting this C scale, I strive for an E top space to be blown with no tongue, and then encourage the player to think the interval to the C in the stave and to play the scale by not changing pitch facially, but by allowing the instrument to take the pitch downwards. This exercise is carried out very calmly. If the ‘bu bu bu’ occurs, show no sign of annoyance or frustration because your student will reflect it – just start again.

The next technique sounds a little crazy, especially as the player may not be very confident using the methods to play any of the notes that I’ve mentioned. Using the Stratos, with its unique adjustment set with the chin-rest piston as far forward as it will go, I encourage the player to reach towards the mouthpiece, sat the same time depressing the chin rest piston spring and closing the gap to the mouthpiece. Although sometimes frustrating, this exercise increases the blood and oxygen to the capillaries, strengthening the mouth muscles. Reaching towards the mouthpiece will feel alien, but will cause no evidence of FD because ‘historic spasms’ won’t be triggered. Maintain this exercise for a full minute, then rest. Return the chin-rest so it is just touching the chin and then play. Results will vary, but I find that the player has better support and, in many cases, plays without the ‘bu bu bu’ effect.

Whistling arpeggios is great, even if a whistle cannot be achieved; just copy the shape as you whistle. Not only does this firm up the oral chamber, but it also encourages the ‘smiling’ muscles to draw forwards towards the point of pitch. Do this exercise very slowly and deliberately, using your mind to picture the travel of the tongue as it arches upwards for the higher whistled notes and then feel the tongue flatten as you descend the arpeggio.

Another strategy is for the player to go into unfamiliar areas, such as striving to pitch above their normal range. The brain won’t know what is happening and so FD won’t be triggered. Once some success has been achieved, work downwards in pitch suspension, not losing sight of the higher note. After descending two or three notes, return to the first note. If these notes feel and sound clear, descend four notes.

Three of my students with FD had never buzzed before, but buzzing keeps the capillaries open, allowing more blood and oxygen into the lips. The brutality of the mouthpiece pressing against flesh needs to be reduced and using the Stratos will achieve this, a little at a time.

Once you’ve made a good start on producing a reasonable sound, you can proceed to rebuilding the embouchure properly. Avoiding old habits is central, but often comes down to basics for a beginner. So progress comes from patient concentration on producing a smooth airflow, correct posture of neck and body, comfortable handling of the instrument and, of course, effective breathing. I recommend looking at the teaching of Kristian Steenstrupp, Professor of Trumpet at the Royal Academy of Music in Aarhus, on this matter.

If the player does not feel that the results are favourable at anytime,
I return to the good notes and start again, which helps to anchor that one good note as a rung on the ladder to eventual success.

Many of the players that I’ve helped are overwhelmed by anxiety to such a degree that they find it immensely difficult to accept there is a way out of their dilemma. It is easy to think ‘why me?’ That attitude, however, only sustains the collapse of the player’s skills and rejection of the instrument that is symptomatic of FD. It is important to recognise that mental attitude to playing is important. I, too, was a ’pro’ making a living as a ‘bone’ player, teaching, conducting and performing for TV and radio. The stress of worrying about how to make a living was the factor that compounded other neuroses that I experienced. The way forward is to try to create different sensations that trick the brain and muscles into re- learning that what they are doing.

I try to create different sensations so that the brain asks what is happening, and, in those moments of confusion by using subterfuge and deception, new and different approaches can be made without rejection. Many alternative avenues are needed for continued progress. For example everything you do to change the feel mentally and sensorily will help this confusion. Even something like wearing gloves, so the instrument feels totally different, can provide a new sensory experience, distracting the brain and aiding progress.

In summary, recovery is possible if the player is patient and works diligently with the tutor.”

This article was originally published in ‘Brass Band World’


You may also be interested to read here about the experiences of Philip Smith (former Principal Trumpet of the New York Philharmonic) with Focal Dystonia.

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