{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T12:27:05Z","timestamp":1768998425630,"version":"3.49.0"},"reference-count":39,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T00:00:00Z","timestamp":1683676800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Musculoskeletal problems in professional brass musicians are very common and often involve the muscles of the embouchure. In rare cases, embouchure dystonia (EmD), a task-specific movement disorder with a wide symptomatic and phenotypic variability, occurs. Following trumpeters and horn players, professional tuba players with and without EmD have now been studied using the latest real-time MRI technology to better understand the underlying pathophysiology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and methods<\/jats:title><jats:p>In the present study, the tongue movement patterns of 11 healthy professional artists and one subject suffering from EmD were compared. The tongue position in the anterior, intermediary and posterior oral cavity were converted into pixel positions based on seven previously generated profile lines, using the established software MATLAB. These data allow a structured comparison of tongue movement patterns between the patient and the healthy subjects, as well as between individual exercises. The main focus of the analysis was on an ascending 7-note harmonic series performed in different playing techniques (slurred, tongued, tenuto and staccato).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Playing the ascending harmonics, a noticeable ascending tongue movement could be observed in the anterior part of the oral cavity in healthy tubists. In the posterior region, there was a slight decrease in oral cavity space. In the EmD patient, hardly any movement was observed at the tongue apex, but in the middle and posterior regions of the oral cavity there was an increase in size the higher the tone became. These distinct differences are relevant for the characterization and a better understanding of the clinical presentation of EmD. Concerning different playing techniques, it was apparent, that notes played slurred or staccato resulted in a larger oral cavity when compared to notes played tongued or tenuto, respectively.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>By using real-time MRI videos, the tongue movements of tuba players can be clearly observed and analyzed. The differences between healthy and diseased tuba players demonstrate the great effects of movement disorders in a small area of the tongue. In order to better understand the compensation of this motor control dysfunction, further studies should investigate further parameters of tone production in all brass players with a larger number of EmD patients additional to the observed movement patterns.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2023.1106217","type":"journal-article","created":{"date-parts":[[2023,5,10]],"date-time":"2023-05-10T14:45:41Z","timestamp":1683729941000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Movement patterns in tuba playing: comparison of an embouchure dystonia case with healthy professional tuba players using real-time MRI imaging"],"prefix":"10.3389","volume":"14","author":[{"given":"Robert","family":"Nelkenstock","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter W.","family":"Iltis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dirk","family":"Voit","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens","family":"Frahm","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Edoardo","family":"Passarotto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eckart","family":"Altenm\u00fcller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,5,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"27","DOI":"10.24451\/arbor.13163","article-title":"Tuba playing and health","volume":"47","author":"Leitner","year":"2020","journal-title":"ITEA J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"93","DOI":"10.21091\/mppa.2002.2013","article-title":"Medical problems of Brass instrumentalists: prevalence rates for trumpet, trombone, French horn, and low Brass","volume":"17","author":"Chesky","year":"2002","journal-title":"Med Probl Perform Art"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1780","DOI":"10.1002\/mds.23654","article-title":"Behavioral factors influence the phenotype of musician\u2019s dystonia","volume":"26","author":"Baur","year":"2011","journal-title":"Mov Disord"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1752","DOI":"10.1002\/mds.22550","article-title":"Embouchure dystonia\u2014portrait of a task-specific cranial dystonia","volume":"24","author":"Frucht","year":"2009","journal-title":"Mov Disord"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1080\/14015430701875653","article-title":"Vocal tract and register changes analysed by real-time MRI in male professional singers-a pilot study","volume":"33","author":"Echternach","year":"2008","journal-title":"Logopedics Phoniatr Vocol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1171","DOI":"10.1007\/s00234-013-1218-x","article-title":"Motor functions in trumpet playing-a real-time MRI analysis","volume":"55","author":"Schumacher","year":"2013","journal-title":"Neuroradiology"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1016\/j.humov.2015.04.013","article-title":"Real-time MRI comparisons of brass players: a methodological pilot study","volume":"42","author":"Iltis","year":"2015","journal-title":"Hum Mov Sci"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/s40734-015-0027-2","article-title":"Divergent oral cavity motor strategies between healthy elite and dystonic horn players","volume":"2","author":"Iltis","year":"2016","journal-title":"J Clin Mov Disord"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s40734-019-0080-3","article-title":"Tongue involvement in embouchure dystonia: new piloting results using real-time MRI of trumpet players","volume":"6","author":"Hellwig","year":"2019","journal-title":"J Clin Mov Disord"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"783","DOI":"10.1007\/s00420-013-0923-4","article-title":"From embouchure problems to embouchure dystonia? 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