Brain morphometry shows effects of long-term musical practice in middle-aged keyboard players

Unhealthy mind in a healthy body: A criticism to eliminativism in psychopathology

In this article we criticize the thesis "The diseases we treat are diseases of the brain". A first criticism is against the eliminativist perspective and in favor of a perspective that is still reductionist but emergentist and functionalist. In a second part, we try to answer the question "under which conditions can we consider this statement legitimate?". We argue that only those mental disorders whose neural substrate has clearly neuropathological characteristics, i.e., anomalies with respect to the laws of good neural functioning, can be considered "brain diseases." We propose that it is not sufficient to observe a simple difference between the brains of people with psychopathology, that is, with anomalies with respect to the laws of good psychological functioning, and that of people without psychopathology. Indeed, we believe it is a categorical error to postulate a neuropathology starting from a psychopathology. Finally, we summarize some research that shows how purely psychological interventions can reduce or eliminate the differences between the brains of people with or psychopathology and those of people without.

Musical Activity During Life Is Associated With Multi-Domain Cognitive and Brain Benefits in Older Adults

Regular musical activity as a complex multimodal lifestyle activity is proposed to be protective against age-related cognitive decline and Alzheimer’s disease. This cross-sectional study investigated the association and interplay between musical instrument playing during life, multi-domain cognitive abilities and brain morphology in older adults (OA) from the DZNE-Longitudinal Cognitive Impairment and Dementia Study (DELCODE) study. Participants reporting having played a musical instrument across three life periods (n = 70) were compared to controls without a history of musical instrument playing (n = 70), well-matched for reserve proxies of education, intelligence, socioeconomic status and physical activity. Participants with musical activity outperformed controls in global cognition, working memory, executive functions, language, and visuospatial abilities, with no effects seen for learning and memory. The musically active group had greater gray matter volume in the somatosensory area, but did not differ from controls in higher-order frontal, temporal, or hippocampal volumes. However, the association between gray matter volume in distributed frontal-to-temporal regions and cognitive abilities was enhanced in participants with musical activity compared to controls. We show that playing a musical instrument during life relates to better late-life cognitive abilities and greater brain capacities in OA. Musical activity may serve as a multimodal enrichment strategy that could help preserve cognitive and brain health in late life. Longitudinal and interventional studies are needed to support this notion.

Physical exercise keeps the brain connected by increasing white matter integrity in healthy controls

ABSTRACT

Physical exercise leads to structural changes in the brain. However, it is unclear whether the initiation or continuous practice of physical exercise causes this effect and whether brain connectivity benefits from exercise. We examined the effect of 6 months of exercise on the brain in participants who exercise regularly (n = 25) and in matched healthy controls (n = 20). Diffusion tensor imaging brain scans were obtained from both groups. Our findings demonstrate that regular physical exercise significantly increases the integrity of white matter fiber tracts, especially those related to frontal function. This implies that exercise improves brain connectivity in healthy individuals, which has important implications for understanding the effect of fitness programs on the brains of healthy subjects.

Neural Plasticity in a French Horn Player with Bilateral Amelia

Precise control of movement and timing play a key role in musical performance. This motor skill requires coordination across multiple joints, muscles, and limbs, which is acquired through extensive musical training from childhood on. Thus, making music can be a strong driver for neuroplasticity. We here present the rare case of a professional french horn player with a congenital bilateral amelia of the upper limbs. We were able to show a unique cerebral and cerebellar somatotopic representation of his toe and feet, that do not follow the characteristic patterns of contralateral cortical and ipsilateral cerebellar layout. Although being a professional horn player who trained his embouchure muscles, including tongue, pharyngeal, and facial muscle usage excessively, there were no obvious signs for an expanded somatosensory representation in this part of the classic homunculus. Compared to the literature and in contrast to control subjects, the musicians' foot movement-related activations occurred in cerebellar areas that are typically more related to hand than to foot activation.

The impact of early musical training on striatal functional connectivity

Evidence from language, visual and sensorimotor learning suggests that training early in life is more effective. The present work explores the hypothesis that learning during sensitive periods involves distinct brain networks in addition to those involved when learning later in life. Expert pianists were tested who started their musical training early (<7 years of age; n = 21) or late (n = 15), but were matched for total lifetime practice. Motor timing expertise was assessed using a musical scale playing task. Brain activity at rest was measured using fMRI and compared with a control group of nonmusicians (n = 17). Functional connectivity from seeds in the striatum revealed a striatal-cortical-sensorimotor network that was observed only in the early-onset group. In this network, higher connectivity correlated with greater motor timing expertise, which resulted from early/late group differences in motor timing expertise. By contrast, networks that differentiated musicians and nonmusicians, namely a striatal-occipital-frontal-cerebellar network in which connectivity was higher in musicians, tended to not show differences between early and late musicians and not be correlated with motor timing expertise. These results parcel musical sensorimotor neuroplasticity into a set of musicianship-related networks and a distinct set of predominantly early-onset networks. The findings lend support to the possibility that we can learn skills more easily early in development because during sensitive periods we recruit distinct brain networks that are no longer implicated in learning later in life.

Increased representation of the non-dominant hand in pianists demonstrated by measurement of 3D morphology of the central sulcus

Background

Post-mortem and magnetic resonance imaging (MRI) studies of the central sulcus, as an indicator of motor cortex, have shown that in the general population there is greater representation of the dominant compared to the non-dominant hand. Studies of musicians, who are highly skilled in performing complex finger movements, have suggested this dominance is affected by musical training, but methods and findings have been mixed.

Objective

In the present study, an automated image analysis pipeline using a 3D mesh approach was applied to measure central sulcus (CS) asymmetry on MR images obtained for a cohort of right-handed pianists and matched controls.

Methods

The depth, length, and surface area (SA) of the CS and thickness of the cortical mantle adjacent to the CS were measured in each cerebral hemisphere by applying the BrainVISA Morphologist 2012 software pipeline to 3D T1-weighted MR images of the brain obtained for 15 right-handed pianists and 14 controls, matched with respect to age, sex, and handedness. Asymmetry indices (AIs) were calculated for each parameter and multivariate analysis of covariance (MANCOVA), and post hoc tests were performed to compare differences between the pianist and control groups.

Results

A one-way MANCOVA across the four AIs, controlling for age and sex, revealed a significant main effect of group (P = 0.04), and post hoc analysis revealed that while SA was significantly greater in the left than the right cerebral hemisphere in controls (P < 0.001), there was no significant difference between left and right SA in the pianists (P = 0.634). Independent samples t-tests revealed that the SA of right CS was significantly larger in pianists compared to controls (P = 0.015), with no between-group differences in left CS.

Conclusions

Application of an image analysis pipeline to 3D MR images has provided robust evidence of significantly increased representation of the non-dominant hand in the brain of pianists compared to age-, sex-, and handedness-matched controls. This finding supports prior research showing structural differences in the central sulcus in musicians and is interpreted to reflect the long-term motor training and high skill level of right-handed pianists in using their left hand.

Enriching activities during childhood are associated with variations in functional connectivity patterns later in life

Enriching early life experiences (e.g., sport, art, music, volunteering, language learning) during a critical period of brain development may promote structural and functional brain changes that are still present decades later (>60 years). We assessed whether a greater variety of enriching early life activities (EELA) before age 13 years were associated with individual differences in cortical and subcortical (hippocampus and amygdala) structure and function later in life (older adults aged 60-80 years). Results indicated no association between EELA and amygdala and hippocampus volumes, but higher functional connectivity between the amygdala and the insula was associated with more variety of EELA. EELA was not associated with cortical thickness controlling for sex, but sex-specific associations with the right pars opercularis were found. EELA was further associated with variations in functional connectivity patterns of the orbitofrontal cortex, driven by connecitivty to regions within the visual, somatosensory and limbic networks. Early life enriching activities appear to contribute to potential mechanisms of cognitive reserve (functional processes) more so than brain reserve (structure) later in life.

Train the brain with music (TBM): brain plasticity and cognitive benefits induced by musical training in elderly people in Germany and Switzerland, a study protocol for an RCT comparing musical instrumental practice to sensitization to music

BACKGROUND

Recent data suggest that musical practice prevents age-related cognitive decline. But experimental evidence remains sparse and no concise information on the neurophysiological bases exists, although cognitive decline represents a major impediment to healthy aging. A challenge in the field of aging is developing training regimens that stimulate neuroplasticity and delay or reverse symptoms of cognitive and cerebral decline. To be successful, these regimens should be easily integrated in daily life and intrinsically motivating. This study combines for the first-time protocolled music practice in elderly with cutting-edge neuroimaging and behavioral approaches, comparing two types of musical education.

METHODS

We conduct a two-site Hannover-Geneva randomized intervention study in altogether 155 retired healthy elderly (64-78) years, (63 in Geneva, 92 in Hannover), offering either piano instruction (experimental group) or musical listening awareness (control group). Over 12 months all participants receive weekly training for 1 hour, and exercise at home for ~ 30 min daily. Both groups study different music styles. Participants are tested at 4 time points (0, 6, and 12 months & post-training (18 months)) on cognitive and perceptual-motor aptitudes as well as via wide-ranging functional and structural neuroimaging and blood sampling.

DISCUSSION

We aim to demonstrate positive transfer effects for faculties traditionally described to decline with age, particularly in the piano group: executive functions, working memory, processing speed, abstract thinking and fine motor skills. Benefits in both groups may show for verbal memory, hearing in noise and subjective well-being. In association with these behavioral benefits we anticipate functional and structural brain plasticity in temporal (medial and lateral), prefrontal and parietal areas and the basal ganglia. We intend exhibiting for the first time that musical activities can provoke important societal impacts by diminishing cognitive and perceptual-motor decline supported by functional and structural brain plasticity.

TRIAL REGISTRATION

The Ethikkomission of the Leibniz Universität Hannover approved the protocol on 14.08.17 (no. 3604-2017), the neuroimaging part and blood sampling was approved by the Hannover Medical School on 07.03.18. The full protocol was approved by the Commission cantonale d'éthique de la recherche de Genève (no. 2016-02224) on 27.02.18 and registered at clinicaltrials.gov on 17.09.18 ( NCT03674931 , no. 81185).

Establishing validity of the fundamentals of spinal surgery (FOSS) simulator as a teaching tool for orthopedic and neurosurgical trainees

BACKGROUND CONTEXT

Pedicle screw placement is a demanding surgical skill as a spine surgeon can face challenges including variations in pedicle morphology and spinal deformities. Available CT simulators for spine pedicle placement can be very costly and hands-on cadaver courses are limited by specimen availability and are not readily accessible.

PURPOSE

To conduct validation of a simulated training device for essential spine surgery skills.

DESIGN

Cross-sectional, empirical study of physician performance on a surgical simulator model.

SAMPLE

Spine attending physicians and residents from four different academic institutions across the United States.

OUTCOME MEASURES

Performance metrics on two surgical simulator tasks.

METHODS

After IRB approval, an inexpensive ($30) simulator was developed to test two main psychomotor tasks (1) creation of the pedicle screw path with a standard gearshift probe without cortical breaks and (2) the ability to palpate for the presence or absence of cortical breaches as well as determine the location of wall defects. Orthopedic and neurosurgery residents (N=72) as well as spine attending surgeons (N=26) participated from four different institutions. To test construct validity, performance metrics were compared between participants of different training status through one-way analysis of variance and linear regression analysis, with significance set at p<.05.

RESULTS

Spine attending surgeons consistently scored higher than the residents, in the screw trajectory task with triangular base (p=.0027) and defect probing task (p=.0035). In defect probing, performance improved with linear trend by number of residency training years with approaching significance (p=.0721). In that task, independent of institutional affiliation, PGY-2 residents correctly identified an average of 1.25±0.43 fewer locations compared with attending physicians (p=.0049). More than 80% of the spine attendings reported they would use the simulator for training purposes.

CONCLUSIONS

This low-cost fundamentals of spine surgery simulator detected differences in performances between spine attending surgeons and surgical residents. Programs should consider implementing a simulator such as fundamentals of spine surgery to assess and develop pedicle screw placement ability outside of the operating room.

How is musical activity associated with cognitive ability in later life?

Research has suggested that individuals who play a musical instrument throughout adulthood have better preserved executive function. However, mixed results have been found for associations between musical activity and visuo-spatial abilities, and less is known about associations with fluid intelligence. We explored differences between musicians (N = 30) and non-musicians (N = 30) aged 60-93 years old across a range of neuropsychological measures of cognitive function. Musicians performed significantly better than non-musicians on all domains, which remained after adjusting for age, gender, educational history, languages spoken and physical activity. As a cross-sectional comparison, the results should not be overstated; however, they are consistent with findings suggesting learning a musical instrument throughout the life course may be associated with cognitive benefits. Identifying potential lifestyle factors that have cognitive benefits in later life, such as musical experience, is an important step in developing intervention strategies for cognitive aging.

Gray Matter Correlates of Creativity in Musical Improvisation

Creativity has been defined as requiring both novelty and effectiveness, but little is known about how this standard definition applies in music. Here, we present results from a pilot study in which we combine behavioral testing in musical improvisation and structural neuroimaging to relate brain structure to performance in a creative musical improvisation task. Thirty-eight subjects completed a novel improvisation continuation task and underwent T1 MRI. Recorded performances were rated by expert jazz instructors for creativity. Voxel-based morphometric analyses on T1 data showed that creativity ratings were negatively associated with gray matter volume in the right inferior temporal gyrus and bilateral hippocampus. The duration of improvisation training, which was significantly correlated with creativity ratings, was negatively associated with gray matter volume in the rolandic operculum. Together, results show that musical improvisation ability and training are associated with gray matter volume in regions that are previously linked to learning and memory formation, perceptual categorization, and sensory integration. The present study takes a first step towards understanding the neuroanatomical basis of musical creativity by relating creative musical improvisation to individual differences in gray matter structure.

A critical view of the quest for brain structural markers of Albert Einstein's special talents (a pot of gold under the rainbow)

Assertions regarding attempts to link glial and macrostructural brain events with cognitive performance regarding Albert Einstein, are critically reviewed. One basic problem arises from attempting to draw causal relationships regarding complex, delicately interactive functional processes involving finely tuned molecular and connectivity phenomena expressed in cognitive performance, based on highly variable brain structural events of a single, aged, formalin fixed brain. Data weaknesses and logical flaws are considered. In other instances, similar neuroanatomical observations received different interpretations and conclusions, as those drawn, e.g., from schizophrenic brains. Observations on white matter events also raise methodological queries. Additionally, neurocognitive considerations on other intellectual aptitudes of A. Einstein were simply ignored.

Motor Cortical Plasticity to Training Started in Childhood: The Example of Piano Players

Converging evidence suggest that motor training is associated with early and late changes of the cortical motor system. Transcranial magnetic stimulation (TMS) offers the possibility to study plastic rearrangements of the motor system in physiological and pathological conditions. We used TMS to characterize long-term changes in upper limb motor cortical representation and interhemispheric inhibition associated with bimanual skill training in pianists who started playing in an early age. Ipsilateral silent period (iSP) and cortical TMS mapping of hand muscles were obtained from 30 strictly right-handed subjects (16 pianists, 14 naïve controls), together with electromyographic recording of mirror movements (MMs) to voluntary hand movements. In controls, motor cortical representation of hand muscles was larger on the dominant (DH) than on the non-dominant hemisphere (NDH). On the contrary, pianists showed symmetric cortical output maps, being their DH less represented than in controls. In naïve subjects, the iSP was smaller on the right vs left abductor pollicis brevis (APB) indicating a weaker inhibition from the NDH to the DH. In pianists, interhemispheric inhibition was more symmetric as their DH was better inhibited than in controls. Electromyographic MMs were observed only in naïve subjects (7/14) and only to voluntary movement of the non-dominant hand. Subjects with MM had a lower iSP area on the right APB compared with all the others. Our findings suggest a more symmetrical motor cortex organization in pianists, both in terms of muscle cortical representation and interhemispheric inhibition. Although we cannot disentangle training-related from preexisting conditions, it is possible that long-term bimanual practice may reshape motor cortical representation and rebalance interhemispheric interactions, which in naïve right-handed subjects would both tend to favour the dominant hemisphere.

Maladaptive Plasticity Induces Degradation of Fine Motor Skills in Musicians

Abstract. Performing music at a professional level is probably one of the most complex human accomplishments requiring extensive training periods. The superior skills of musicians are mirrored in plastic adaptations of the brain involving gray and white matter increase in sensory motor and auditory areas and enlargement of receptive fields. Motor disturbances in musicians are common and include mild forms, such as temporary motor fatigue, painful overuse injuries following prolonged practice, anxiety-related motor failures during performances, and more persistent losses of motor control, termed “dynamic stereotypes.” Musician’s dystonia is characterized by a permanent loss of motor control when playing a musical instrument linked to genetic susceptibility and to maladaptive plasticity. In this review article, we argue that these motor failures developing on a continuum from motor fatigue to musician’s dystonia require client tailored treatment and accordingly specific psychological and neurological interventions.

It's Sad but I Like It: The Neural Dissociation Between Musical Emotions and Liking in Experts and Laypersons

Emotion-related areas of the brain, such as the medial frontal cortices, amygdala, and striatum, are activated during listening to sad or happy music as well as during listening to pleasurable music. Indeed, in music, like in other arts, sad and happy emotions might co-exist and be distinct from emotions of pleasure or enjoyment. Here we aimed at discerning the neural correlates of sadness or happiness in music as opposed those related to musical enjoyment. We further investigated whether musical expertise modulates the neural activity during affective listening of music. To these aims, 13 musicians and 16 non-musicians brought to the lab their most liked and disliked musical pieces with a happy and sad connotation. Based on a listening test, we selected the most representative 18 sec excerpts of the emotions of interest for each individual participant. Functional magnetic resonance imaging (fMRI) recordings were obtained while subjects listened to and rated the excerpts. The cortico-thalamo-striatal reward circuit and motor areas were more active during liked than disliked music, whereas only the auditory cortex and the right amygdala were more active for disliked over liked music. These results discern the brain structures responsible for the perception of sad and happy emotions in music from those related to musical enjoyment. We also obtained novel evidence for functional differences in the limbic system associated with musical expertise, by showing enhanced liking-related activity in fronto-insular and cingulate areas in musicians.

Structural and functional plasticity specific to musical training with wind instruments

Numerous neuroimaging studies have shown structural and functional changes resulting from musical training. Among these studies, changes in primary sensory areas are mostly related to motor functions. In this study, we looked for some similar functional and structural changes in other functional modalities, such as somatosensory function, by examining the effects of musical training with wind instruments. We found significant changes in two aspects of neuroplasticity, cortical thickness, and resting-state neuronal networks. A group of subjects with several years of continuous musical training and who are currently playing in university wind ensembles showed differences in cortical thickness in lip- and tongue-related brain areas vs. non-music playing subjects. Cortical thickness in lip-related brain areas was significantly thicker and that in tongue-related areas was significantly thinner in the music playing group compared with that in the non-music playing group. Association analysis of lip-related areas in the music playing group showed that the increase in cortical thickness was caused by musical training. In addition, seed-based correlation analysis showed differential activation in the precentral gyrus and supplementary motor areas (SMA) between the music and non-music playing groups. These results suggest that high-intensity training with specific musical instruments could induce structural changes in related anatomical areas and could also generate a new functional neuronal network in the brain.

Physical Exercise Keeps the Brain Connected: Biking Increases White Matter Integrity in Patients With Schizophrenia and Healthy Controls

It has been shown that learning a new skill leads to structural changes in the brain. However, it is unclear whether it is the acquisition or continuous practicing of the skill that causes this effect and whether brain connectivity of patients with schizophrenia can benefit from such practice. We examined the effect of 6 months exercise on a stationary bicycle on the brain in patients with schizophrenia and healthy controls. Biking is an endemic skill in the Netherlands and thus offers an ideal situation to disentangle the effects of learning vs practice. The 33 participating patients with schizophrenia and 48 healthy individuals were assigned to either one of two conditions, ie, physical exercise or life-as-usual, balanced for diagnosis. Diffusion tensor imaging brain scans were made prior to and after intervention. We demonstrate that irrespective of diagnosis regular physical exercise of an overlearned skill, such as bicycling, significantly increases the integrity, especially of motor functioning related, white matter fiber tracts whereas life-as-usual leads to a decrease in fiber integrity. Our findings imply that exercise of an overlearned physical skill improves brain connectivity in patients and healthy individuals. This has important implications for understanding the effect of fitness programs on the brain in both healthy subjects and patients with schizophrenia. Moreover, the outcome may even apply to the nonphysical realm.

Glial Regulation of the Neuronal Connectome through Local and Long-Distant Communication

If "the connectome" represents a complete map of anatomical and functional connectivity in the brain, it should also include glia. Glia define and regulate both the brain's anatomical and functional connectivity over a broad range of length scales, spanning the whole brain to subcellular domains of synaptic interactions. This Perspective article examines glial interactions with the neuronal connectome (including long-range networks, local circuits, and individual synaptic connections) and highlights opportunities for future research. Our understanding of the structure and function of the neuronal connectome would be incomplete without an understanding of how all types of glia contribute to neuronal connectivity and function, from single synapses to circuits.

Investigating Neuroanatomical Features in Top Athletes at the Single Subject Level

In sport events like Olympic Games or World Championships competitive athletes keep pushing the boundaries of human performance. Compared to team sports, high achievements in many athletic disciplines depend solely on the individual's performance. Contrasting previous research looking for expertise-related differences in brain anatomy at the group level, we aim to demonstrate changes in individual top athlete's brain, which would be averaged out in a group analysis. We compared structural magnetic resonance images (MRI) of three professional track-and-field athletes to age-, gender- and education-matched control subjects. To determine brain features specific to these top athletes, we tested for significant deviations in structural grey matter density between each of the three top athletes and a carefully matched control sample. While total brain volumes were comparable between athletes and controls, we show regional grey matter differences in striatum and thalamus. The demonstrated brain anatomy patterns remained stable and were detected after 2 years with Olympic Games in between. We also found differences in the fusiform gyrus in two top long jumpers. We interpret our findings in reward-related areas as correlates of top athletes' persistency to reach top-level skill performance over years.

Neuroplasticity beyond Sounds: Neural Adaptations Following Long-Term Musical Aesthetic Experiences

Capitalizing from neuroscience knowledge on how individuals are affected by the sound environment, we propose to adopt a cybernetic and ecological point of view on the musical aesthetic experience, which includes subprocesses, such as feature extraction and integration, early affective reactions and motor actions, style mastering and conceptualization, emotion and proprioception, evaluation and preference. In this perspective, the role of the listener/composer/performer is seen as that of an active “agent” coping in highly individual ways with the sounds. The findings concerning the neural adaptations in musicians, following long-term exposure to music, are then reviewed by keeping in mind the distinct subprocesses of a musical aesthetic experience. We conclude that these neural adaptations can be conceived of as the immediate and lifelong interactions with multisensorial stimuli (having a predominant auditory component), which result in lasting changes of the internal state of the “agent”. In a continuous loop, these changes affect, in turn, the subprocesses involved in a musical aesthetic experience, towards the final goal of achieving better perceptual, motor and proprioceptive responses to the immediate demands of the sounding environment. The resulting neural adaptations in musicians closely depend on the duration of the interactions, the starting age, the involvement of attention, the amount of motor practice and the musical genre played.

Apollo's gift: new aspects of neurologic music therapy

Music listening and music making activities are powerful tools to engage multisensory and motor networks, induce changes within these networks, and foster links between distant, but functionally related brain regions with continued and life-long musical practice. These multimodal effects of music together with music's ability to tap into the emotion and reward system in the brain can be used to facilitate and enhance therapeutic approaches geared toward rehabilitating and restoring neurological dysfunctions and impairments of an acquired or congenital brain disorder. In this article, we review plastic changes in functional networks and structural components of the brain in response to short- and long-term music listening and music making activities. The specific influence of music on the developing brain is emphasized and possible transfer effects on emotional and cognitive processes are discussed. Furthermore, we present data on the potential of using musical tools and activities to support and facilitate neurorehabilitation. We will focus on interventions such as melodic intonation therapy and music-supported motor rehabilitation to showcase the effects of neurologic music therapies and discuss their underlying neural mechanisms.

Apollo's curse: neurological causes of motor impairments in musicians

Performing music at a professional level is probably one of the most complex human accomplishments. Extremely fast and complex, temporo-spatially predefined movement patterns have to be learned, memorized, and retrieved with high reliability in order to meet the expectations of listeners. Performing music requires not only the integration of multimodal sensory and motor information, and its precise monitoring via auditory and kinesthetic feedback, but also emotional communicative skills, which provide a "speaking" rendition of a musical masterpiece. To acquire these specialized auditory-sensory-motor and emotional skills, musicians must undergo extensive training periods over many years, which start in early childhood and continue on through stages of increasing physical and strategic complexities. Performance anxiety, linked to high societal pressures such as the fear of failure and heightened self-demands, frequently accompanies these learning processes. Motor disturbances in musicians are common and include mild forms, such as temporary motor fatigue with short-term reduction of motor skills, painful overuse injuries following prolonged practice, anxiety-related motor failures during performances (choking under pressure), as well as more persistent losses of motor control, here termed "dynamic stereotypes" (DSs). Musician's dystonia (MD), which is characterized by the permanent loss of control of highly skilled movements when playing a musical instrument, is the gravest manifestation of dysfunctional motor programs, frequently linked to a genetic susceptibility to develop such motor disturbances. In this review chapter, we focus on different types of motor failures in musicians. We argue that motor failures in musicians develop along a continuum, starting with subtle transient degradations due to fatigue, overuse, or performance stress, which transform by and by into more permanent, still fluctuating motor degradations, the DSs, until a more irreversible condition, MD manifests. We will review the epidemiology and the principles of medical treatment of MD and discuss prevention strategies.