State anxiety disorganizes finger movements during musical performance

Examining surgeon stress in robotic and laparoscopic surgery

Robotic surgery may decrease surgeon stress compared to laparoscopic. To evaluate intraoperative surgeon stress, we measured salivary alpha-amylase and cortisol. We hypothesized robotic elicited lower increases in surgeon salivary amylase and cortisol than laparoscopic. Surgical faculty (n = 7) performing laparoscopic and robotic operations participated. Demographics: age, years in practice, time using laparoscopic vs robotic, comfort level and enthusiasm for each. Operative data included operative time, WRVU (surgical "effort"), resident year. Saliva was collected using passive drool collection system at beginning, middle and end of each case; amylase and cortisol measured using ELISA. Standard values were created using 7-minute exercise (HIIT), collecting saliva pre- and post-workout. Linear regression and Student's t test used for statistical analysis; p values < 0.05 were significant. Ninety-four cases (56 robotic, 38 laparoscopic) were collected (April-October 2022). Standardized change in amylase was 8.4 ± 4.5 (p < 0.001). Among operations, raw maximum amylase change in laparoscopic and robotic was 23.4 ± 11.5 and 22.2 ± 13.4; raw maximum cortisol change was 44.21 ± 46.57 and 53.21 ± 50.36, respectively. Values normalized to individual surgeon HIIT response, WRVU, and operative time, showing 40% decrease in amylase in robotic: 0.095 ± 0.12, vs laparoscopic: 0.164 ± 0.16 (p < 0.02). Normalized change in cortisol was: laparoscopic 0.30 ± 0.44, robotic 0.22 ± 0.4 (p = NS). On linear regression (p < 0.001), surgeons comfortable with complex laparoscopic cases had lower change in normalized amylase (p < 0.01); comfort with complex robotic was not significant. Robotic may be less physiologically stressful, eliciting less increase in salivary amylase than laparoscopic. Comfort with complex laparoscopic decreased stress in robotic, suggesting laparoscopic experience is valuable prior to robotic.

Impact of music performance anxiety on cardiovascular blood pressure responses, autonomic tone and baroreceptor sensitivity to a western classical music piano-concert

Introduction

Music Performance Anxiety (MPA) is a prevalent condition among musicians that can manifest both psychologically and physiologically, leading to impaired musical performance. Physiologically, MPA is characterized by excessive muscular and/or autonomic tone. This study focuses on the cardiovascular blood pressure responses, autonomic tone and baroreceptor sensitivity changes that occur during musical performance due to MPA.

Methods

Six professional pianists perform a piece for piano written only for the left hand by Alexander Scriabin. The following parameters have been studied during the performance: ECG, non-invasive beat to beat continuous arterial blood pressure and skin conductance. Sympathetic and parasympathetic autonomic flow was studied with Wigner-Ville analysis (W-V) from R-R ECG variability, and baroreceptor sensitivity with the Continuous Wavelet Transform (CWT).

Results

During the concert a significant increase of heart rate, systolic, mean and diastolic arterial pressure were observed. No significant differences were found in skin conductance. The W-V analysis, which studies frequency changes in the time domain, shows a significant increase of sympathetic flow and a decrease of parasympathetic flow during the concert which is associated with a significant decrease in sympathetic and vagal baroreceptor sensitivity.

Discussion

The study of cardiac variability using the Wigner-Ville analysis may be a suitable method to assess the autonomic response in the context of MPA, and could be used as biofeedback in personalized multimodal treatments.

Symptoms of and coping strategies for music performance anxiety through different time periods

Music performance anxiety (MPA) manifests itself at mental, physiological, and behavioral levels. The present study investigated how the experience of the three levels of symptoms changes over time, and how musicians cope with these temporal changes in MPA symptoms. To this end, we conducted a questionnaire survey in which 38 student musicians freely commented on their experiences of mental and physical changes, as well as their coping strategies for these changes. This was examined during five different time periods around public performance, extending from the beginning of the preparation for a public performance until shortly before the next public performance. The free-text comments obtained from the questionnaire were analyzed thematically and classified into different response themes. We then examined the temporal changes in the frequency of comments on each response theme. We further conducted a semi-structured interview involving eight musicians to explore the responses to the questionnaire in greater detail. We analyzed the contents of the free-text comments obtained from the questionnaire and the interview for each response theme, focusing on the most frequently mentioned sub-themes. The results indicate that musicians started to experience mental MPA symptoms (e.g., negative feelings) as soon as they began to prepare for public performance. To cope with mental symptoms, musicians employed mental strategies such as positive thinking/self-talk and concentration both before and during public performance. The experience of physiological MPA symptoms (e.g., increased heart rate) peaked shortly before public performance and remained throughout performance. To cope with a variety of physiological symptoms, musicians employed physical strategies, especially deep breathing and exercise, shortly before public performance. In contrast, behavioral MPA symptoms (e.g., tremor) were experienced mostly during public performance. Some musicians also reported experiencing the actual impairment of performance quality. To avoid this, musicians employed a variety of practicing techniques (e.g., playing at a slower tempo) during the preparation for public performance and performing techniques (e.g., paying attention to expressions) during public performance. Together, the present findings indicate that mental, physiological, and behavioral symptoms of MPA exhibit differential timelines and that musicians effectively utilize different coping strategies according to the temporal changes in MPA symptoms.

Can anxiety-like behavior and spatial memory predict the extremes of skilled walking performance in mice? An exploratory, preliminary study

Introduction

Skilled walking is influenced by memory, stress, and anxiety. While this is evident in cases of neurological disorders, memory, and anxiety traits may predict skilled walking performance even in normal functioning. Here, we address whether spatial memory and anxiety-like behavior can predict skilled walking performance in mice.

Methods

A cohort of 60 adult mice underwent a behavioral assessment including general exploration (open field), anxiety-like behavior (elevated plus maze), working and spatial memory (Y-maze and Barnes maze), and skilled walking performance (ladder walking test). Three groups were established based on their skilled walking performance: superior (SP, percentiles ≥75), regular (RP, percentiles 74-26), and inferior (IP, percentiles ≤25) performers.

Results

Animals from the SP and IP groups spent more time in the elevated plus maze closed arms compared to the RP group. With every second spent in the elevated plus maze closed arms, the probability of the animal exhibiting extreme percentiles in the ladder walking test increased by 1.4%. Moreover, animals that spent 219 s (73% of the total time of the test) or more in those arms were 4.67 times more likely to exhibit either higher or lower percentiles of skilled walking performance.

Discussion

We discuss and conclude anxiety traits may influence skilled walking performance in facility-reared mice.

The plyometric activity as a conditioning to enhance strength and precision of the finger movements in pianists

Stability of timing and force production in repetitive movements characterizes skillful motor behaviors such as surgery and playing musical instruments. However, even trained individuals such as musicians undergo further extensive training for the improvement of these skills. Previous studies that investigated the lower extremity movements such as jumping and sprinting demonstrated enhancement of the maximum force and rate of force development immediately after the plyometric exercises. However, it remains unknown whether the plyometric exercises enhance the stability of timing and force production of the dexterous finger movements in trained individuals. Here we address this issue by examining the effects of plyometric exercise specialized for finger movements on piano performance. We compared the training-related changes in the piano-key motion and several physiological features of the finger muscles (e.g., electromyography, rate of force development, and muscle temperature) by well-trained pianists. The conditioning demonstrated a decrease of the variation in timing and velocity of successive keystrokes, along with a concomitant increase in the rate of force development of the four fingers, but not the thumb, although there was no change in the finger muscular activities through the activity. By contrast, such a conditioning effect was not evident following a conventional repetitive piano practice. In addition, a significant increase in the forearm muscle temperature was observed specifically through performing the plyometric exercise with the fingers, implying its association with improved performance. These results indicate effectiveness of the plyometric exercises for improvement of strength, precision, and physiological efficiency of the finger movements even in expert pianists, which implicates that ways of practicing play a key role in enhancing experts' expertise.

Selective effects of psychosocial stress on plan based movement selection

Efficient movement selection is crucial in everyday activities. Whether this function is governed by our stress system is so far unknown. In the current study, data from thirty-six young male adults were analyzed. They performed rule- and plan-based movement selection tasks before (session 1) and after (session 2) a psychosocial stressor, or after a control condition without additional social stressor. Results showed that the rule-based efficiency advantage which was observed prior to the psychosocial stressor was significantly reduced afterwards in the whole sample, as well as in the stress group. Regression analyses revealed that this effect was due to a modulation of the plan-based approach. Especially variations-both increase and decrease-in the parasympathetic activity (reflected by the heart rate variability measure RMSSD) appeared to be disadvantageous for plan-based movement selection improvement. In contrast, performance in the rule-based movement selection tasks appeared to be rather invariant to external influences. The current results suggest that autonomic nervous system activity might modulate motor-cognitive performance. This modulatory capability might be selective for plan-based approaches, hence the applied strategy to movement selection could be decisive when it comes to the vulnerability of motor-cognitive processes towards psychosocial stress.

Back to feedback: aberrant sensorimotor control in music performance under pressure

Precisely timed production of dexterous actions is often destabilized in anxiogenic situations. Previous studies demonstrated that cognitive functions such as attention and working memory as well as autonomic nervous functions are susceptible to psychological stress in skillful performance while playing sports or musical instruments. However, it is not known whether the degradation of sensorimotor functions underlies such a compromise of skillful performance due to psychophysiological distress. Here, we addressed this issue through a set of behavioral experiments. After artificially delaying the timing of tone production while playing the piano, the local tempo was abnormally disrupted only under pressure. The results suggest that psychological stress degraded the temporal stability of movement control due to an abnormal increase in feedback gain. A learning experiment further demonstrated that the temporal instability of auditory-motor control under pressure was alleviated after practicing piano while ignoring delayed auditory feedback but not after practicing while compensating for the delayed feedback. Together, these findings suggest an abnormal transition from feedforward to feedback control in expert piano performance with psychological stress, which can be mitigated through specialized sensorimotor training that involves piano practice while volitionally ignoring the artificially delayed provision of auditory feedback.

In order to establish if the degradation of sensorimotor functions underlies the stress-associated disruption of skilful performance, Furuya et al examined participants undergoing a piano playing task under stress. Their data suggests the occurrence of a stress-induced transition from feedforward to feedback control, which can be mitigated through sensorimotor training involving piano practice while volitionally ignoring the artificially delayed provision of auditory feedback.

Effects of social anxiety on static and dynamic balance task assessment in older women

BACKGROUND

Social anxiety caused by the presence of an evaluator can impair balance performance in older women. However, it is unknown whether co-performing balance tasks with a partner mitigates this effect.

RESEARCH QUESTION

Does the presence of a partner mitigate the effect of social anxiety on static and dynamic balance assessment in older women?

METHODS

Twenty-one older women (mean age 66.5 (SD = 5.2) years) performed nine balance tasks under three conditions: (a) Alone (no evaluator present); (b) Evaluator (male evaluator present); (c) Partner (evaluator + performing tasks in parallel with partner). Participants were split into two groups post-hoc: Affected (n = 10) and Unaffected (n = 11), based on their emotional response to the presence of the evaluator (increased self-reported anxiety and fear).

RESULTS

The affected group took a longer time to complete tandem walking with eyes open in the Evaluator vs. Alone condition, but not in the Partner condition. Both groups increased anterior-posterior trunk angular velocity during tandem walking with eyes closed in the Evaluator vs. Alone condition, but not in the Partner condition.

SIGNIFICANCE

Social anxiety impairs the balance performance of older women, particularly in those most affected by the evaluator, and during more dynamic modified gait tasks that challenge balance while walking. However, co-performing balance tasks with a partner reduced the effects of social anxiety, suggesting that social support may help to mitigate some of the potential 'white coat' effects experienced during clinical balance assessments.

Factors of choking under pressure in musicians

Under pressure, motor actions, such as those required in public speech, surgery, or musical performance, can be compromised, even when these have been well-trained. The latter is often referred to as 'choking' under pressure. Although multifaceted problems mediate such performance failure in anxiogenic situations, such as compromised motor dexterity and cognitive disruption, the fundamental set of abnormalities characterizing choking under pressure and how these abnormalities are related have not been elucidated. Here, we attempted, first, to classify behavioural, psychological, and physiological abnormalities associated with choking under pressure in musicians and, second, to identify their relationship based on datasets derived from a questionnaire with 258 pianist respondents. Explorative factor analysis demonstrated eight functional abnormalities related to the musicians' choking, such as attention to the audience, erroneous motor actions, perceptual confusion, and failure of memory recall, which however did not include exaggerated attention to the performance. This suggests distraction of attention away from skill execution, which may underlie the spoiled performance under pressure. A structural equation analysis further inferred causal relationships among them. For instance, while failure of memory recall was influenced by passive behaviours manifesting under pressure, erroneous motor actions during performance were influenced by feeling rushed and a loss of body control. In addition, some specific personal traits, such as neuroticism, public self-consciousness, and a lack of confidence, were associated with the extent to which pressure brought about these abnormalities. These findings suggest that distinct psycho-behavioural abnormalities and personal traits underlie the detrimental effects of pressure on musical performance.

The effects of anxiety and dual-task on upper limb motor control of chronic stroke survivors

This study was designed to investigate the effects of anxiety and dual-task on reach and grasp motor control in chronic stroke survivors compared with age- and sex-matched healthy subjects (HC). Reach and grasp kinematic data of 68 participants (high-anxiety stroke (HA-stroke), n = 17; low-anxiety stroke (LA-stroke), n = 17; low-anxiety HC, n = 17; and high-anxiety HC, n = 17) were recorded under single- and dual-task conditions. Inefficient reach and grasp of stroke participants, especially HA-stroke were found compared with the control groups under single- and dual-task conditions as evidenced by longer movement time (MT), lower and earlier peak velocity (PV) as well as delayed and smaller hand opening. The effects of dual-task on reach and grasp kinematic measures were similar between HCs and stroke participants (i.e., increased MT, decreased PV that occurred earlier, and delayed and decreased hand opening), with greater effect in stroke groups than HCs, and in HA-stroke group than LA-stroke group. The results indicate that performing a well-learned upper limb movement with concurrent cognitive task leads to decreased efficiency of motor control in chronic stroke survivors compared with HCs. HA-stroke participants were more adversely affected by challenging dual-task conditions, underlying importance of assessing anxiety and designing effective interventions for it in chronic stroke survivors.

Testing to Identify Submaximal Effort: Lifting to a Perceived 50% Effort vs. an Assigned Submaximal Load

Swift, MC, Townsend, R, Edwards, D, and Loudon, J. Testing to identify submaximal effort: Lifting to a perceived 50% effort vs. an assigned submaximal load. J Strength Cond Res XX(X): 000-000, 2020-The ability to accurately measure effort during postinjury functional testing allows for the validation of displayed physical limitations by injured workers. The Cross-Reference Testing System (XRTS) has been developed to identify submaximal efforts through distraction-based dynamic material handling testing. The XRTS material handling assessment compares dynamic lifts of weights in a crate and lifts using a lever arm device. The purpose of this study was to determine whether subjects lifting an assigned submaximal load influence test results compared with subjects lifting to but not exceeding a 50% perceived effort. Subjects in group A (n = 35) were assigned the condition to attempt to lift to but not exceed a randomly assigned weight value for both the crate lift and XRTS at 3 lifting heights. Subjects in group B (n = 32) were asked to lift to but not exceed 37.5 lb from the same 3 lifting heights. The reproducibility of effort was measured with current validity criteria for distraction-based material handling testing. Using the percent difference values, a 2 × 3 (group, lifting height) analysis of variance (ANOVA) was performed to test the hypothesis. The alpha level was set at 0.05. The mean percent change between comparative lifts was 31.13%, 95% CI (22.51-39.75) for group A and 29.26% 95% CI (21.91-36.61) for group B. The 2 × 3 ANOVA demonstrated no significant difference (p = 0.751) between groups. The results indicate attempting to lift to a perceived 50% effort was not significantly different from attempting to lift to but not exceed an assigned submaximal load.

Reorganization of finger covariation patterns represented in the corticospinal system by learning of a novel movement irrelevant to common daily movements

How dexterous finger movements are acquired by the nervous system is a fundamental question in the neuroscience field. Previous studies have demonstrated that finger movements can be decomposed into finger covariation patterns, and these patterns are represented in the corticospinal system. However, it remains unclear how such covariation patterns represented in the corticospinal system develop during the acquisition of novel finger movements. In this study, each subject learned to perform a novel finger movement, which was mapped to a region outside the movement subspace spanned by common finger movements seen in daily life, through a custom task. After subjects practiced the task, we detected changes in the finger covariation patterns derived from artificially (transcranial magnetic stimulation) evoked finger joint movements. The artificially evoked movement-derived patterns seen after the training period were associated with both the novel and common finger movements. Regarding the patterns extracted from the artificially evoked movements, the number required to explain most of the variance in the data was unchanged after the training period. Our results indicate that novel finger movements are acquired through the reorganization of preexisting finger covariation patterns represented in the corticospinal system rather than the development of new patterns. These findings might have implications for the basic mechanism responsible for the development of movement repertories in the nervous system.NEW & NOTEWORTHY Various types of finger movements involve common finger covariation patterns, and these patterns are represented in the corticospinal system. Here we examined how a novel finger covariation pattern is acquired in that system through training of a novel finger movement that is irrelevant to common finger movements. Using transcranial magnetic stimulation, we found that the preexisting patterns that contribute to finer control of finger movements are rapidly reorganized to encode the novel pattern through the training.

Integrating piezoresistive sensors on the embouchure analysis of the lower lip in single reed instrumentalists: implementation of the lip pressure appliance (LPA)

Background

It is essential to understand, characterize, and measure the embouchure mechanism of a wind instrumentalists, where the applied forces on the perioral tissues can usually promote discomfort or pain.

Methods

The sample consisted of five clarinet players and five saxophone players. The embouchure force measurements at the lower lip area were assessed using a piezoresistive sensor (FlexiForceTM, Tekscan, Boston, USA, 0.07 kgf/cm2) placed on the lower part of the mouthpiece of the single reed instrument. Furthermore, each participant performed three times three different notes at different pitches: high, medium, and low. An intraoral device was manufactured in order to dissipate the existing pressures.

Results

The piezoresistive sensors applied to the mouthpiece of the five clarinetists presented values between 16 and 226 g of force. In the case of the five saxophonists, the values registered were between 5 and 320 g of force.

Conclusions

Piezoresistive sensors are a valid option to characterize that single reed instrumentalists apply substantial forces at the lower lip that can be equivalent to medium orthodontic forces. The implementation of the Lip Pressure Appliance can be a valid solution on the prevention of eventual lesions resulting from the embouchure forces.