The Cerebral Palsy Pianist
The Cerebral Palsy Pianist
In 2009, blind pianist Nobuyuki Tsuji tied for first place in the Van Cliburn International Piano Competition. Such an extraordinary accomplishment provides hope for those with disabilities so they may thrive regardless of their circumstance. Even those who do not wish to become a professional musician can harness the power of musical training to serve as their outlet for creative expression and their tool to deal with cognitive impairments. Children with attention deficit hyperactivity disorder, dyslexia, autism, and other sensory processing disabilities have also shown improvement in the hindered abilities that are present in their individual situations. The potential for musical instrument training is even supported after a study was done showing improvement of neural efficiency in the verbal memory of older adults, ages 61 to 85 years old.
Because training in musical instruments improves many areas of the brain and can ultimately increase the mental facilities of any individual who dedicates sufficient time and practice, consistent training may be applied to those with disabilities, specifically those with Cerebral Palsy, so that they are better able to take on daily tasks and handle obstacles that require a great amount of mental focus. Musical training works as a kind of sensorimotor rehabilitation, improving overall movement in those that have difficulty with large and small muscle groups functioning together fluidly.
A new and vast field of the benefits of musical training for patients with cerebral palsy is developing thanks to the emphasis on current research. Because playing an instrument demands the use of sensory information in the context of a motor task, it can actually improve skills in a person whose sensorimotor interactions are known to be impaired. More than any other simple motor training, musical training can have a greater impact on improving coordination, thanks to the recruitment of the entire central nervous system.
“Cerebral Palsy: Science and Clinical Practice” describes Cerebral Palsy (CP) as the predisposition to varying degrees of impairments related to mobility, cognitive processing, and communication. In specifically the area of gross motor function, the effects vary from person to person, but in all cases day to day living is impacted negatively. For example, there are CP patients who cannot hold themselves to sit upright and may need a posture chair for support. In this case, adjustments are made to help the student sit in a functional position for playing the piano.
Cerebral Palsy is not a cognitive disease; therefore, patients’ minds are not limited in potential for how it can attain skills and progress. Many people with cerebral palsy have average or above average cognition. The problem lies teaching fine motor skills that are restricted from the disease. 1 in 5 people with CP have a moderate to severe intellectual impairment. Generally, we a see a greater level of intellectual impairment with a greater level of physical impairment, but that is not always the case. Some patients with severe physical impairment have little to no intellectual disability and vice versa. This information is vital to better understanding our students with Cerebral Palsy and their long-term potential to musical learning. The greatest challenge is posed by the impairments in fine motor and gross motor coordination.
Lights that indicate which note to play on a keyboard, termed follow lights, is an established device for allowing students with little knowledge on reading music to quickly learn pieces. A note will be glow with a bright light will not turn off until the user presses it. Then, the next note in the sequence will light up and the process continues. Follow lights are a visual aid for students to be able to eventually transition into reading music and are just as accessible to older beginners who wish to quickly learn some of their favorite songs. Students with disabilities can also utilize the simplicity of this technology since many of them have cognitive barriers limiting the rate in which they learn how to read music. Yamaha is one of the piano companies who developed a digital piano with follow lights. The possibilities of repertoire are endless thanks to the capabilities of MIDI. For example, the theme for Jurassic Park can be played, starting with the follow lights letting you imitate the colossal sounds of a stomping dinosaur, and File:Media/SALimage1.jpegthen the melody is introduced for you to play back.
Lampe, Turova, and Alves-Pinto conducted a study using a piano glove, one worn by the teacher and the other by the CP student, where the teacher can guide the student to have more focus into smaller areas of the body, such as their fingers. The piano glove also solves a deficiency of using follow lights alone for students with more severe CP, which is that “They are only a visual aid and do not take into account the difficulties in recognizing and differentiating the fingers, the deficits in eye-hand coordination, impaired spatial orientation, and other sensorimotor disabilities.” The teachers glove receives the input from every finger that is pressed and sends the signal to the vibration motors within the student’s glove.
Those who do not have access to this kind of equipment can find it useful to use teaching techniques that can still provide similar benefits to a student with CP. A ride along approach with the teacher’s hand guiding the student’s hand is one of the most practical methods ensure accurate playing of the notes. Rhythmic content can be broken down into a deconstructed skill by asking students to clap or create sounds that are consistent with a visual aid of rhythms provided by the teacher. Melodic phrases contained within piano pieces can also be sung by the student, with the teacher asking for as much articulation and dynamic interpretation as possible depending on the student. Randall Faber and Mary Kathryn Archuleta have a checklist to teaching beginners with special needs and breaks it down into the following: First, segment a skill into its most elemental components. Then, use a non-verbal prompt or instruction that is appropriate to the task such as demonstrating or hand-over-hand guidance. Lastly, use step-by-step trials and reward each positive performance.
File:Media/SALimage2.jpeg Unilateral Cerebral Palsy is a condition that affects muscle control and function on one side of the body. If a unilateral Cerebral Palsy patient has damage to the left side of the brain, then the right side of the body will be affected. Piano pieces and methods that are dedicated to training one hand only can be utilized to be suit this particular case of CP. Let’s Play Piano WITH LEFT HAND ONLY by Heather Milnes is a resource for beginner pianists that are only able to use their left hand. Because it is more common to receive injuries in the right arm or hand due to overuse, the amount of left hand only repertoire is bountiful compared to right hand only. Training of the Left Hand, Op. 89 by Berens published by Schirmer is book of forty-six exercises and twenty-five studies for the left hand alone. This is an excellent resource for advanced pianists who are not able to use their right hand. Those with CP that are not able to use their right hand and do not have such a severe impairment with overall gross motor function hand can also take benefit from this book. Harry Meyerowitz: Three Piano Compositions for the Right Hand Alone is a resource that proves that there is some right-hand piano repertoire available and would be of use to those with CP who cannot use their left hand.
File:Media/SALimage3.jpegSynthesia is a software that can take midi files of piano pieces and program them into a keyboard that has a midi jack. Synthesia works as a kind of digital guide to learning music. With the use of a monitor, Synthesia shows the notes of the piano that are required to be pressed, and the student has to follow along. Users of Synthesia can practice the melody of hands separate or hands together at any tempo they desire, and the software will give feedback as to whether the notes are correct or incorrect. Teachers can use Smartscore X Pro and scan sheet music, or a digital copy (which converts easier) and the software will read the sheet music and once it has finished, the file can be saved as a midi file. Synthesia can then use that file and students can now play their piece.
This photo shows the basic concept of Synthesia and it may be possible to add follow lights to go along with the falling sheet music.
Students with cerebral palsy have many alternatives on learning the piano depending on their particular needs and limitations. Those with less severe physical impairments can benefit from the repertoire for the one hand as well as the follow lights paired with the Synthesia program for learning pieces. The piano glove and the practical applications that can be derived from it shows that the pedagogical umbrella for piano students now includes students with a variety of physically limiting disabilities. The wide array of methods for learning music available to students with CP, as well as the benefits musical training has for enhancing daily functioning and handling of tasks in those students’ personal lives, highlight the necessity for further research and attention in this field which is of a significance that is only just being realized.
Bibliography
Dan, Bernard, Lewis Rosenbloom, Nigel Paneth, and Margaret Mayston. Cerebral Palsy : Science and Clinical Practice. Clinics in Developmental Medicine. London: Mac Keith Press, 2014. https://search.ebscohost.com/login.aspx?direct=true&db=nlebk&AN=921129&site=eds-live&scope=site.
Kim, Soo Ji, Ga Eul Yoo, Yoon‐Kyum Shin, and Sung‐Rae Cho. 2020. “Gait Training for Adults with Cerebral Palsy Following Harmonic Modification in Rhythmic Auditory Stimulation.” Annals of the New York Academy of Sciences 1473 (1): 11–19. doi:10.1111/nyas.14306.
Alves-Pinto, Ana, Varvara Turova, Tobias Blumenstein, and Renée Lampe. 2016. “The Case for Musical Instrument Training in Cerebral Palsy for Neurorehabilitation.” Neural Plasticity, October, 1–9. doi:10.1155/2016/1072301.
Lampe, Renée, Varvara Turova, and Ana Alves-Pinto. 2019. “Piano Jacket for Perceiving and Playing Music for Patients with Cerebral Palsy.” Disability & Rehabilitation: Assistive Technology 14 (3): 221–25. doi:10.1080/17483107.2017.1419384.
Tobias Blumenstein, Varvara Turova, Ana Alves-Pinto, Renée Lampe. 2016. "Sensorimotor Piano System for People with Disabilities", Journal of Sensors, vol. 2016. doi:/10.1155/2016/9825905
Guo, Xia, Masatoshi Yamashita, Maki Suzuki, Chie Ohsawa, Kohei Asano, Nobuhito Abe, Takahiro Soshi, and Kaoru Sekiyama. 2021. “Musical Instrument Training Program Improves Verbal Memory and Neural Efficiency in Novice Older Adults.” Human Brain Mapping 42 (5): 1359–75. https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=149047232&site=eds-live&scope=site.
Rose, Dawn, Alice Jones Bartoli, and Pamela Heaton. 2018. “Learning a Musical Instrument Can Benefit a Child with Special Educational Needs.” Psychomusicology: Music, Mind, and Brain 28 (2): 71–81. doi:10.1037/pmu0000209.