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Tremor in Instrumentalists: Influence of Tremor Type on Performance

Richard J. Lederman
From: Medical Problems of Performing Artists: Volume 22 Number 2: Page 70 (June 2007)

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Abstract: Objective: To review the types of tremor seen in instrumental musicians and assess the impact on the musicians¿ careers. Tremor of the limb, lip, jaw, or larynx can be particularly disruptive to an instrumentalist. Methods: Forty-six instrumental musicians were identified who specifically noted tremor interfering with musical activity. Tremor associated only with performance anxiety was excluded. Follow-up information was obtained by personal examination or telephone interview. Results: Twenty-six musicians (22 men, 4 women), aged 17 to 70 yrs at evaluation, had essential tremor. All had hand tremor; 2 primarily had lip tremor, and 1 vocal tremor. Instruments included 13 bowed strings, 5 woodwind, 3 keyboard, 2 guitar, and 1 each brass, percussion, and voice. Thirteen musicians currently use medication as needed; 1 is deceased; 1 no longer plays; and 4 were lost to follow-up. Sixteen with dystonic tremor (12 men, 4 women) were age 19 to 53 yrs at evaluation: 6 had embouchure tremor (4 brass, 2 woodwind) and 10 limb tremor (5 violin, 2 percussion, 1 each piano, banjo, and clarinet). Four play unimpaired; 3 remain mildly impaired; 5 remain in music but do not play; 3 have nonmusic careers; and 1 was lost to follow-up. Four patients had Parkinson¿s disease (2 men, 2 women), aged 34 to 71 at evaluation: 2 piano, 1 cello, and 1 bassoon. All had hand tremor and impaired dexterity that interfered with playing. One is deceased, another has stopped playing, and 2 continue to play with medication. Conclusions: Tremor can have a major impact on instrumental performance. Accurate identification of tremor type is critical for effective management and career counseling.

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