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Empowering musicians: teaching, transforming, living: promoting health and wellbeing when making music: a holistic approach in music education.

Why is making music one of the most challenging human experiences?

Performing music, be it as student, teacher or as concert virtuoso, is probably one of the most challenging human accomplishments. Highly complex, temporo-spatially predefined movement patterns have to be learned, stored and retrieved with high reliability to meet one's own or the listener's expectations. Playing an instrument or singing requires not only the integration of multimodal sensory and motor information and its precise monitoring via auditory, kinesthetic or visual feedback, but also planning of movements and anticipation of sounds produced. Although technical mastery is important, so is developing emotional communicative skills to accomplish a "touching" rendition of a musical piece. To acquire all these specialized auditory-sensory-motor and emotional skills, practice is required.

In 1993, Anders Ericsson and his colleagues undertook a study on practice with students at the Berlin Academy of Music majoring in performance. (1) These students had spent about 10,000 hours at their instruments, whereas amateur musicians of the same age had spent only 1,500 hours. Ericsson proposed the concept of "deliberate practice," defining it as "goal-oriented, structured and effortful practice" in which motivation, resources and focused attention determine amount and quality of time spent at the instrument. As a consequence, the amount of deliberate practice is a crucial factor in developing instrumental skills to a high level. Successful musicians are more likely to plan, image, monitor and control their playing by focusing their attention on what they are practicing and how it can be improved.

This concept has been refined in the past years since it became clear that the amount of deliberate practice depends on factors linked to motivation, self-management, parental support and teacher-student-relationship. Furthermore, not only the amount of practice is important but also the age, when a child starts to play. Inception of musical practice before age 7 leads to optimized, more efficient and more stable motor programs as opposed to practice starting after puberty. Obviously, for sensory-motor skills, such as fast individuated finger movements, there exists sensitive periods or "windows of opportunity," during the development and maturation of the central nervous system.

Music is shaping mind and body

The acquisition of all these skills is mirrored in plastic adaptations of both the body and the brain of the musician. In terms of bodily adaptations, postural musculature will develop to maintain frequently prolonged uncomfortable positions, such as holding a viola for hours with the left arm or a flute with the right. Fibrous tissue and calluses will develop in the tips of the left hand of cellists, double bass players, guitarists and harpists. In high string players, mobility of elbow joints of the left arm will increase as a reaction to reaching the low strings on the grip board. And in brass players, embouchure musculature will be accentuated to control sound quality, to name but a few of these bodily changes.

Most dramatic are the adaptations of the central nervous system, usually subsumed under the term "brain plasticity." Brain regions in the frontal cortex related to motor planning and execution, as well as regions in the temporal cortex responsible for processing auditory information, will develop more grey matter, in other words larger neurons and denser neuronal networks. The same holds true for nerve centers of the basal ganglia, (specifically in the so-called putamen) required for making movements automatic. White matter in the brain, which consists of nerve fibers and their isolating myelin sheaths, will develop in those networks, promoting fast information exchange. These kinds of adaptations can be observed in the callosal body, the large connection between the left and right hemispheres of the brain, and in the arcuate fascicle, which links auditory perception and motor planning.

These plastic adaptations have positive consequences--or transfer effects--upon general cognitive emotional and motor abilities, as research into children and adolescents who learn to play an instrument has demonstrated. Improved executive functions allow a more efficient guidance of attention and promote the ability to suppress irrelevant information and to process relevant information at a faster speed. Memory functions, more specifically auditory memory necessary for language acguisition, will benefit from musical training as well as the ability to identify emotions in spoken language. Finger-tapping speed, precise two-hand coordination, and acquisition of skilled sequential finger movements (such as those necessary to handle a smart phone and the like) will improve. However, these effects of neuroplasticity are not limited to the young; the elderly also benefit from musical experiences. Making music with seniors improves life quality and mood, short- and long-term memory, hand dexterity, social connectedness and may even prevent dementia to a certain extent.

Why is it important to care for wellbeing when learning musical skills?

All these beneficial effects of making music depend not only on practicing but also on positive emotional involvement while playing. Here the role of music educators is crucial. We know from research into musical learning that motivation and success depend on a learning environment that allows to develop what Gary McPherson termed "sense of competence." (2) Sense of competence results from mastery experiences, sufficient opportunities to demonstrate newly acquired skills, initiative and freedom of choice of musical activities, and a sense of being personally in charge of one's own behavior and therefore able to cope with difficulties. Uncomfortable feelings of tenseness, pain during and after practicing, anxieties accompanying lessons or performances will counteract these positive learning experiences and will sooner or later cause loss of joy in making music. Obviously it is important to implement prevention strategies in the early stages of musical learning experiences.

Health-conscious behavior, to maintain wellbeing when playing, should be a topic from the very first lesson. This starts with carefully preparing students for the bodily needs of the instrument, demonstrating warm-ups and stretches. It continues with training of self-awareness and mindfulness, especially focusing on proprioception and economy, and ease of movements. Training of auditory sensitivity will be of upmost importance, since musical learning takes place under the guidance of auditory perception and is in many respects self-organizing, in other terms "learning by doing." Indeed, it seems that highly talented students are characterized by their superior auditory imagination and by their motor intelligence, finding the most appropriate and economic movements in short time. Practice schedules should be discussed and adapted according to the demands of instruments, pieces and to personal stress factors including situational pressures. Practice sessions should provide a variety of musical challenges to avoid mental and/or motor fatigue. Frequent pauses should be planned, since musical learning and consolidation of motor memories mainly takes place during breaks and during sleep. Mental training, learning new pieces from reading the score without physically playing them, should be included since this is an excellent technique to avoid overuse and mental fatigue. Generally, students should be taught to organize their practice experience according to their individual bodily and mental needs. Frequently, especially in highly motivated young musicians, it is important to encourage students to avoid over practicing, before physical limits are exceeded, and to prevent them from exaggerated, destructive perfectionism and self-criticism. These latter personality traits are frequently dominant sources of anxieties and stage fright. Finally, and most importantly, musical understanding, imagination, colour, fantasy and emotion are not only part of any artistic expression but also of a vivid teacher-student relationship. Here, a rich artistic environment, empathy and emotional depth will contribute to a successful musical education and interaction.

Ways to go.

In the last 10 years, music educators worldwide have not only recognized the enormous impact of health issues on musical practice but also realized that making music in turn is a powerful means to improve general wellbeing, life quality and emotional stability. With respect to the professional training in conservatories and universities, prevention of chronic pain, of movement disorders, of hearing loss or of severe psychological problems has gained increasing attention. In many of these institutions, musician's medicine specialists are now available and promote prevention, treatment and research in the field. In Germany, during the last 22 years, these programs have been introduced nearly nationwide. Our efforts have yielded fruits: the incidence rate of medical issues, such as chronic pain and musician's dystonia (a movement disorder characterized by a loss of voluntary movements when playing an instrument) has declined, although general stressors and professional pressures have grown. I am convinced that newer international initiatives, such as the establishment of a special interest group named "Musician's Health and Wellness" within the International Society for Music Education (ISME), will further advance these positive developments in the future.


(1.) Ericsson, K.A., Krampe, R.T., Tesch-Romer, C., 1993. The role of deliberate practice in the acquisition of expert performance. Psychol. Rev., 100, 363-06.

(2.) McPherson, G., 2009. The role of parents in childrens' musical development. Psychology of Music, 37, page 91-110.

Eckart Altenmuller is a neurologist, holding a master's degree in flute performance. He is director of the Institute of Music Physiology and Musicians' Medicine and vice president of the University of Music, Drama and Media, Hannover.
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Title Annotation:Professional Resources
Author:Altenmuller, Eckart
Publication:American Music Teacher
Geographic Code:1USA
Date:Jun 1, 2016
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