Item

Abstract

Background: The embouchure of trumpet players is of utmost importance for tone production and quality of
playing. It requires skilled coordination of lips, facial muscles, tongue, oral cavity, larynx and breathing and has to be
maintained by steady practice. In rare cases, embouchure dystonia (EmD), a highly task specific movement disorder,
may cause deterioration of sound quality and reduced control of tongue and lip movements. In order to better
understand the pathophysiology of this movement disorder, we use real-time MRI to analyse differences in tongue
movements between healthy trumpet players and professional players with embouchure dystonia.

Methods: Real-time MRI videos (with sound recording) were acquired at 55 frames per second, while 10 healthy
subjects and 4 patients with EmD performed a defined set of exercises on an MRI-compatible trumpet inside a 3
Tesla MRI system. To allow for a comparison of tongue movements between players, temporal changes of MRI
signal intensities were analysed along 7 standardized positions of the tongue using a customised MATLAB toolkit.
Detailed results of movements within the oral cavity during performance of an ascending slurred 11-note harmonic
series are presented.

Results: Playing trumpet in the higher register requires a very precise and stable narrowing of the free oral cavity.
For this purpose the anterior section of the tongue is used as a valve in order to speed up airflow in a controlled
manner. Conversely, the posterior part of the tongue is much less involved in the regulation of air speed. The
results further demonstrate that healthy trumpet players control movements of the tongue rather precisely and
stable during a sustained tone, whereas trumpet players with EmD exhibit much higher variability in tongue movements.

Conclusion: Control of the anterior tongue in trumpet playing emerges as a critical feature for regulating air speed
and, ultimately, achieving a high-quality performance. In EmD the observation of less coordinated tongue
movements suggests the presence of compensatory patterns in an attempt to regulate (or correct) pitch. Increased
variability of the anterior tongue could be an objective sign of dystonia that has to be examined in further studies
and extended to other brass instruments and may be also a potential target for therapy options.