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Courage Kenny Rehabilitation Institute

Musicians' Clinic

Jennine Speier examines a patient.

Jennine Speier, MD, provides care to Laurel Green, second violinist in the Minnesota Orchestra.

Musicians' Clinic

The demands of musical practice and performance can lead to pain as well as dexterity problems.

Injuries related or unrelated to playing can interfere with musicians' ability to play their instruments or resume a desired musical lifestyle.

Medications and brief rest are often not enough to resolve the problem. Courage Kenny Rehabilitation Institute's rehabilitation professionals recognize the importance of specialized medical services for instrumental artists.

The goals of the clinic are making an early, accurate diagnosis, defining a treatment plan and preventing future injury.

Evaluation

For more information,
call the Musicians' Clinic at
612-863-4495.

An initial examination is performed by a physician specializing in rehabilitation medicine (a physiatrist) with expertise in neurologic and musculoskeletal conditions, overuse or repetitive movement injuries and posture-related problems associated with musical instruments.

Musicians are examined with and without their instruments.

Location

This program is offered through Courage Kenny Rehabilitation Institute in Minneapolis, Abbott Northwestern Hospital.

800 East 28th Street
Minneapolis, MN 55407
612-863-4495

Directions and parking: 612-863-5550
Metro Transit trip planner

A complete performance history is obtained, including practice and performance schedules, body position and playing techniques.

Other medical specialists, including orthopaedic surgeons and neurologists, who are aware of a musician's challenges, are also available for consultation.


Source: Sister Kenny Rehabilitation Institute
Reviewed by: Jennine Speier, MD, physiatrist, director of the Musicians' Clinic.
First Published: 03/22/2011
Last Reviewed: 03/01/2011

Treatment

Physical and occupational therapy services are prescribed as needed, primarily through Courage Kenny Rehabilitation Institute's Hand Therapy.

Therapists have years of experience with specific occupational and instrument demands and problems encountered by musicians.

Services include, but are not limited to, the following:

  • myofascial release, ultrasound, electrical stimulation, joint mobilization and therapeutic exercise
  • fabrication of devices to help support and reposition the instrument; modification of instrument and chin rests
  • specialized rehabilitation of hand injuries, including splinting to stabilize joints, if needed
  • therapies include incorporating instrument use, often with biofeedback and video analysis
  • development of graduated warm-up, exercise and practice schedules to allow safe resumption of reasonable playing demands
  • education covering problem-solving, practice and playing techniques to prevent re-injury and future problems.
Proforma Vision in use.

ProForma Vision

ProForma Vision is a software program that utilizes real-time video and EMG (electrical activity of muscles) readings of musicians playing their instruments to help them optimize their performance, diagnose underlying causes of injury, and design treatment plans that will return the musicians to healthier playing.

Simultaneous data from signals from a MIDI piano keyboard enable analysis of force, ability to relax tension, and velocity of movement of finger and forearm muscles.

This facilitates diagnosis and treatment of specific finger and wrist overuse and/or weakness, as well as timing of muscle activation.

Abnormalities of muscle activation can immediately be correlated with a visual image of limb position and posture.

This therapy tool is particularly helpful in diagnosing and treating musicians with overuse, tendon irritation muscle strain and focal dystonia. It is also applicable to patients with weakness and coordination difficulties associated with neurologic injuries such as stroke.


Source: Sister Kenny Rehabilitation Institute
Reviewed by: Jennine Speier, MD, physiatrist, director of the Musicians' Clinic.
First Published: 03/22/2011
Last Reviewed: 03/01/2011
Musicians' Clinic

Other services

Additional services through the Musicians' Clinic include:

  • social services
  • counseling psychology (performance anxiety)
  • pool therapy
  • nutritional counseling
  • integrative medicine (massage, acupuncture, guided imagery)
  • speech therapy, including vocal disorders
  • therapists experienced with Feldenkreis, Pilates.

Technical advice is available through consultation with Janet Horvath, associate principal cellist of the Minnesota Orchestra, and author of "Playing (Less) Hurt," as well as other community musicians.

Physician services are provided primarily by Jennine Speier, MD, physiatrist, director of the Musicians' Clinic, and Paul Schaefer, MD, who specializes in the treatment of performing artists.

Other physicians of Courage Kenny Rehabilitation Associates will provide services as appropriate.

Musicians are encouraged to bring their instruments with them for the initial evaluation and treatment sessions. DVDs of the musician during performance are also useful.


Source: Sister Kenny Rehabilitation Institute
Reviewed by: Jennine Speier, MD, physiatrist, director of the Musicians' Clinic
First Published: 03/22/2011
Last Reviewed: 03/01/2011

Musicians' Clinic: Helping people perform at their best

The Twin Cities have long been known for their commitment to the performing arts. Beginning in the late 1980s, Sister Kenny Rehabilitation Institute recognized a need to extend rehabilitation services to musicians and performing artists.

Jennine Speier, MD, provides care to Laurel Green, second violinist in the Minnesota Orchestra.

That's when Jennine Speier, MD, and the late Richard Owen, MD, cofounded the Musicians' Clinic at Sister Kenny Rehabilitation Institute.

Today, Speier serves as medical director for the Musicians' Clinic which is committed to specialized rehabilitation services for instrumental artists and musicians of all levels.

Although the clinic primarily focuses on musicians, its rehabilitation professionals have cared for other performing artists, including actors and vocalists suffering from vocal cord injuries or trauma.

According to Speier, the demands of musical practice and performance, with its repetitive and intense nature, may lead to pain and injuries. Musicians and performing artists from across the United States and internationally have been cared for at the clinic with the goals of making an early and accurate diagnosis, defining a treatment plan and preventing future injury.

Over the years, Speier has cared for a wide variety of musicians in all genres— from jazz, blues, folk, rock to classical. These musicians range from beginners to weekend performers to professionals and players of all kinds of instruments, from strings to winds and brass to percussion.

Musicians seek care at the clinic for a wide variety of issues such as common muscle strain, tendonitis, shoulder and neck pain, as well as rare neurological conditions. Medications and brief rest are often not enough to resolve the problem. Or, in the case of professional musicians, rest may not be an option.

"Our strength is our depth of experience," said Speier. "There isn't a medical practice group around with the years of experience that we have in treating musicians." This level of experience has drawn patients from as far away as Australia to seek care at the clinic. "We're always learning from each other to make sure that we are optimizing care," she added.

On average, patients are seen for an initial visit with Speier and six sessions of prescribed therapy. Speier's background and knowledge of resources for performing artists is vast. For example, if a string player could benefit from a custom-made chin or shoulder rest, Speier has local and national experts she works with to create the perfect fit.

Or, if a flutist needs a key adjustment, Speier and her colleagues will work directly with a flute maker to assist in determining the appropriate adjustment.

If helpful, Speier may connect directly with a musician's teacher to better understand the history, practice and performance schedule and playing technique. When necessary, Speier brings her network of other medical subspecialists — orthopedic surgeons, neurologists and neurosurgeons — into the patient care team.

Pressure and perfection

The pressure to excel and perform is common with young, as well as seasoned musicians. The stress and repetitive nature of a musician's life of intense practice and performance is comparable to that of an athlete in many aspects.

Speier credits the work of Janet Horvath, associate principal cellist of the Minnesota Orchestra for 33 years and the author of Playing (Less) Hurt, in helping to promote the importance of performing arts medicine.

"Janet increased awareness of performing arts medicine, offered solutions from a musician's standpoint, and set a climate for us where it's okay to talk about it," said Speier. "Previously, musicians often played through their pain."

Speier notes that some musicians are proactively addressing issues before they become a problem, including hypermobility or joint issues. Teachers may refer a student to the clinic when they notice a playing technique, body position or other issue that may present challenges to the musician in the future.

"We see musicians in their late teens or early 20s, or preparing to head to college to study music," said Speier. "And we see seasoned musicians with decades of experience who are professionals or resuming their music practice. Our therapists get immersed and love the creative aspects of working with musicians," said Speier.

She recalls when one of the Institute's hand therapists was working with an oboe player. In this particular case, the therapist worked with the oboe player to learn as much as possible about improving the ergonomics of reed making.

The clinic's team has also made field trips to nearby churches to help organists by assessing their technique on an organ similar to the one they play in their local community.

Occasionally, the professionals at the clinic have worked with composers, disc jockeys, arranging or recording engineers and others in the performing arts field. In emergencies, Speier has worked with professional musicians on tour in the Twin Cities area to address an injury so that they are able to continue a performance or tour.

For Speier, working with patients is professionally and personally rewarding. "These dedicated patients apply the same level of discipline to get better as they do to their musical practice," said Speier. "Whether they are an amateur, a professional or retired, we share the joy with our patients when they get back to playing and performing."

Source: Possibilities newsletter, Spring 2013
Reviewed by: Jennine Speier, MD, physiatrist, director of the Musicians' Clinic
First Published: 03/14/2013
Last Reviewed: 03/14/2013
David Rohan

David Rohan is a 2013 Inspiration Award winner

Moving back to music after a stroke

David Rohan of St. Paul Park, Minnesota experienced a stroke this past spring at the age of 39. During hospitalization, he had to be intubated and received a tracheostomy. He also had a GI tube due to impaired swallowing. In addition, he was diagnosed with stress cardiomyopathy. Nevertheless, he progressed to walking with the use of a platform walker before he was discharged from the hospital.

Rohan transitioned to outpatient therapy at Courage Kenny Rehabilitation Institute – United Hospital. During the course of his therapy, he made great progress in mobility, balance and decreased risk for falls, according to his physical therapist, Jennifer Steel, PT, DPT, NCS. He was able to participate in dynamic activities during therapy, including rapid transitional movements and coordination activities such as jumping and skipping. He can now walk without an assistive device or gait belt.

As a musician who played multiple instruments including guitar, piano, drums, trumpet and saxophone, and provided guitar instruction, Rohan also began therapy in Courage Kenny Rehabilitation Institute’s Musicians’ Clinic. Jeanine Speier, MD, physiatrist and director of the Musicians’ Clinic, has told Rohan that he may be able to return to teaching in the near future. Despite his physical challenges, he is striving to achieve that goal.

Rohan is also participating in speech therapy. “In Dave’s case specifically,” said Steel, “the number and wide range of caregivers involved in his care speaks volumes to success that can happen when the ‘whole self’ is treated in a trans-disciplinary care model.”

Steel also remarked on how Rohan’s hard work has inspired other patients who are being treated at the same time in the gym. They are motivated to challenge themselves to set and achieve higher goals. His wife, Deb, has also encouraged other caregivers; and both of them have maintained contact with patients they met along Rohan’s journey, concerned about those patients’ recovery and well being.

Steel summed it up by saying, “From a therapist’s point of view, patients like Dave allow us to join in the joys of success and most importantly remind us why we do what we do.” As he moves back to music instruction, Rohan will serve as a model that life after a stroke is still possible and enjoyable – and worth all the hard work.

Billy McLaughlin poses with guitar

For more on Billy McLaughlin, his background and his ongoing efforts to raise awareness of dystonia and support research for a cure, go to billymclaughlin.com.

Musician resumed career despite debilitating condition

Billy McLaughlin's love of the guitar began when he was in 7th grade. He played through his teens, earned a degree in guitar performance at the University of California and went on to become a star in the 1980s, touring the country and performing more than 200 concerts a year.

Then in 1998, a freak fall on an icy patch of ground began a downward spiral. Despite physical therapy on his injured hand, he no longer had the ability to play the guitar effortlessly and without errors.

McLaughlin said, "What was shocking to me was missing notes and phrases I'd played perfectly THOUSANDS of times without thinking. Losing control of my body, of my music, of the beauty of the moment, of the simplest series of notes, was not only shocking and humiliating - it was utterly unexplainable!"

For the next few years, McLaughlin saw therapists and specialists to no avail, and was even told that his condition might be psychological, perhaps even "hysteria." He faded from the musical scene.

Then in 2001, McLaughlin made an appointment to see Jennine Speier, MD, physiatrist and lead physician at Sister Kenny Rehabilitation Institute's Musicians' Clinic.

Within minutes, Speier diagnosed him as having focal dystonia, a movement disorder that causes the muscles to contract and spasm involuntarily. Speier told him that he wasn't losing his mind, but rather that "his brain was losing his fingers."

"Diagnosis was the first step for me," said McLaughlin. I had been stuck until I knew what was wrong. Now I could move forward and plan for my life. As I got my head around the fact of my diagnosis, I was left with a tough choice and knew I'd have to do something quite unusual."

And that he did! After 25 years of playing the guitar right handed, he began to teach himself to play with his left hand. While he admits that he can't do everything he did before, he has adapted well enough to resume his musical career with remarkable success.

McLaughlin advises others to "make the best of what you have, knowing that you have new things to discover and can learn to adapt to anything that comes your way."