What I Choose to Become

"I am What I Choose to Become": How Ingrid Clarfield Reinvented Her Musical Life After Stroke

By Swarna Kuruganti and Mukul Pandya

Psychologist Carl Jung is believed to have said, “I am not what happened to me; I am what I choose to become.” This statement aptly describes the inspiring journey of Ingrid Clarfield, a gifted piano teacher who has refused to let a life-altering stroke define her, derail her passion for music and teaching, or steal her identity.

Clarfield’s story, captured in the inspiring documentary “Take a Bow,” (accessible via Amazon Prime) is one of courage, creativity, and resilience. It shows how human ingenuity, aided by technology, can combine to help stroke survivors reclaim their identities and continue pursuing their life’s work.

In March 2007, Clarfield’s life took an unexpected turn. A professor of piano at Westminster Choir College in Princeton, N.J., for more than four decades, Clarfield awoke one morning, stood up, and immediately collapsed. At age 60, she had suffered a severe stroke that left her unable to use her left arm and leg.

For a pianist and teacher whose life revolved around the keyboard, this could have been a career-ending blow. But Clarfield, drawing on an inner strength rooted in her family history of resilience, refused to accept this as the end of her musical journey. “My parents fled Nazi Germany, so we’re survivors,” Clarfield says. This survivor’s mentality, ingrained in her from childhood, became the foundation for her ability to bounce forward from her stroke.

Redefining Her Approach

Faced with the inability to play piano with both hands, many might have given up. Clarfield, however, saw this as a challenge to overcome rather than an insurmountable obstacle. She began to explore ways to continue teaching and performing, refusing to be sidelined by her physical limitations.

Her innovative solution was to enlist “guest left hand artists” – pianists who would play the left-hand parts while she played the right. This approach allowed her to continue performing in lecture-recitals. “I’ve had more than 40 people do it,” Clarfield says. “One of the greatest challenges  is finding the right person. Usually after doing my research I’m lucky and find somebody who’s a wonderful musician and really committed to doing a great job by practicing a lot of the music I sent in advance.”

This method not only allowed Clarfield to continue her work but also opened up new avenues for musical collaboration and teaching.

In her teaching, Clarfield found that her experience actually enhanced her ability to convey certain musical concepts. For example, when teaching students about the left hand in a piece, she now has them play the left hand while she plays the right – a reversal of roles that provides a unique learning experience.

“I discovered that my students do that better than anyone because of that,” she says. “I had to learn to do that. There are times when I try to play both parts with one hand, and I hit a wrong note. And when my students laugh, I say, ‘Don’t laugh. It’s okay. I’m doing fine.’”

Technology as an Enabler

While Clarfield’s “guest left hand” approach was innovative, technology has played an equally crucial role in her journey to keep teaching and performing. Various assistive devices helped her regain mobility and independence, allowing her to focus on her music.

A significant technological aid that proved transformative in the initial weeks after Clarfield’s stroke was the Bioness device for her left arm. This system, known as the Bioness H200 Wireless Hand Rehabilitation System, uses functional electrical stimulation (FES) to help patients regain hand and arm function. The H200 consists of a lightweight, ergonomically designed orthosis that fits around the forearm and hand, and a small control unit that can be worn on the waist or arm.

The Bioness system works by delivering low-level electrical stimulation to activate nerves and muscles in the forearm and hand. This stimulation can help improve hand function, increase range of motion, reduce muscle spasms, and even reeducate muscles over time. For stroke survivors like Clarfield, this can mean regaining the ability to open and close the hand, grasp objects, and perform other essential daily tasks.

For Clarfield, the Bioness device represented a moment of hope in her recovery journey. “I still remember the very first time I felt my fingers move. I was so excited,” she recalls. While the device didn’t fully restore function to her left hand, it provided enough improvement to boost her spirits and fuel her determination to continue her musical career.

Another crucial aid for Clarfield, which she started using about a year later, was a device called the WalkAide. This small, battery-powered device attaches to her leg and uses electrical stimulation to activate nerves and muscles, enabling her to walk. The WalkAide works by addressing a condition known as foot drop, which is common among stroke survivors and can make walking difficult and unsafe.
Before discovering the WalkAide, Clarfield was resistant to traditional assistive devices for walking. She particularly disliked the idea of wearing a foot brace, known as an AFO (Ankle Foot Orthosis). “I hated it, because it made you wear big, ugly shoes, and you couldn’t really walk. Well, I couldn’t,” she notes. This reluctance to compromise on her appearance and mobility led her to seek out more advanced technological solutions.

The WalkAide is worn just below the knee and uses advanced tilt sensor technology to detect the leg’s position. As the user walks, the device sends electrical signals to the nerve that controls ankle dorsiflexion (lifting the foot). This stimulation causes the foot to lift at the appropriate time during the gait cycle, allowing for a more natural and efficient walking pattern. The result is improved mobility, reduced risk of falls, and increased independence for users like Clarfield.

“I’ve had [my WalkAide] for 15 years,” Clarfield says. “It still works. Unfortunately, many people can’t afford it — it costs $5,000 to $6,000. Now you may be able to buy it for less, but I can’t walk without it.”

The impact of this technology on Clarfield’s life cannot be overstated. It has allowed her to regain mobility, which was crucial for her ability to continue teaching and performing. “I can walk. I can’t imagine not having it,” she says. It has also allowed her to go regularly for physical and occupational therapy at the Lawrence Rehab Center in New Jersey for the past 17 years.

The use of these technologies in Clarfield’s recovery underscores the potential of assistive devices to improve the quality of life and mental health for stroke survivors. However, as Clarfield notes, the high cost of these devices can be a barrier for many patients. This highlights the need for continued R&D in this field, with a focus on making such technologies more accessible to all who need them.

Adaptability and Resilience

Clarfield’s use of technology is just one aspect of her adaptability and resilience. She also had to rethink many aspects of her daily life and professional practice, finding creative solutions to challenges that many would find overwhelming.

For instance, she has adapted her wardrobe to accommodate her limited mobility. “I took all my earrings that had posts and converted them into ones with hooks that I could put into my ear piercing with my one good hand,” she explains. This attention to detail extends to her necklaces, which now use magnetic clasps for easy wearing.

Clarfield’s adaptability extended to her approach to therapy as well. In the first few weeks after the stroke, she was dismissive of speech therapy, finding the exercises frustrating and irrelevant. “I said, ‘This is stupid. I won’t do it,’” she recalls. However, her perspective changed when she found a therapist who tailored the approach to her needs. This therapist studied Clarfield’s website and asked questions about her work and interests, making the therapy both engaging and relevant. ‘She had taken the time to see what kind of music books I had written and the work I had done. She asked me to make a list of things I would need if I had to travel to attend a conference,” Clarfield explains. This personalized approach made a significant difference in her engagement with and benefit from speech therapy.

The Role of AI and Future Technologies

While Clarfield has made effective use of existing technologies, the potential of artificial intelligence (AI) and advanced robotics in assisting stroke survivors is an area of growing interest and debate. When presented with the possibility of a robotic arm that could perform the left-hand parts of piano pieces, Clarfield’s response reveals both her openness to innovation and her deep understanding of the nuances of musical performance.

“I would love to say, it’s a great idea, go for it,” she says. However, she also points out potential challenges: “Music is so much about emotion and freedom. I don’t play metronomically. If I’m playing Chopin, there’s freedom all over the place. Somebody has to be able to follow me.”

This insight highlights a crucial aspect of music that current AI and robotic technologies struggle to replicate – the emotional interpretation and spontaneity that are hallmarks of great musical performances. “I am also the kind of performer who talks when I play,” Clarfield notes. “I may say, ‘This is a perfect example of where [French composer Claude] Debussy does this. And I stop, so the left hand person has to know me and the music well enough to do this.”

While current technology might not be able to fully replicate the nuanced interaction between musicians, Clarfield remains open to future possibilities. “It would intrigue me to see somebody try it,” she says, demonstrating her continued curiosity and willingness to embrace new ideas.

The idea of brain-computer interfaces (BCI) that could potentially translate thought into action for a robotic arm is another area of emerging technology that could benefit stroke survivors. While Clarfield expresses skepticism about using such technology herself at this point in her career, she acknowledges that it might have been appealing earlier in her recovery journey. “Had you asked me that 17 years ago, you might have gotten a different answer,” she says. This perspective underscores the importance of timing and individual circumstances in the adoption of assistive technologies.

Clarfield’s openness extends to the use of AI in music composition. When asked about the possibility of AI composing pieces for one-handed pianists, she responds with enthusiasm: “I am curious to see if AI would do this well. Would it sound like one hand or like two hands? A good one-hand piece sounds like two hands.” This curiosity about AI’s potential in music composition reflects Clarfield’s engagement with new developments in her field.

The Human Factor

Despite her embrace of technology, Clarfield’s story ultimately underscores the value of human connection and emotion in both music and recovery. Her success in maintaining a positive mental attitude in her recovery and continuing her career owes as much to her personality, determination, and ability to connect with others as it does to any technological aid.

This is evident in her approach to performance with her “guest left hand” collaborators. “I don’t treat them like robots,” she notes. “I’ll say, hey, what do you think? I make jokes about it. We don’t start together. We’re not perfect. I go, Oops, I screwed that one up. So that’s music for me. We’re not perfect.”

It’s also clear in her teaching philosophy, which emphasizes individual interpretation and emotion over rigid adherence to a score. “I don’t want your child to be a robot,” she tells parents who question why their child’s performance differs from a recording they’ve heard.

Clarfield’s journey highlights the importance of community in recovery. She speaks fondly of the friendships she’s formed with other stroke survivors, including an annual dinner she shares with a fellow survivor on their “stroke-aversary.”

Today, 17 years after her stroke, Clarfield continues to teach, perform, and inspire. She has written numerous books on piano pedagogy, including a new three-book series scheduled to be released soon. She travels for conferences and masterclasses, sharing her knowledge and her story with musicians and educators around the country.

As AI and robotic technologies continue to advance, Clarfield’s story offers valuable insights into their potential applications and limitations in fields that require nuanced human interaction and emotional expression. It reminds us that while technology can be a powerful enabler, it is the human spirit – with its capacity for creativity and connection – that truly drives transformation and achievement.

Clarfield’s journey illustrates Carl Jung’s sentiment perfectly. She has indeed become what she chose to become – not a victim of circumstance, but a survivor, an innovator, and an inspiration to musicians and stroke survivors alike.

About the authors

Swarna Kurungati

Swarna Kuruganti is the Managing Partner at Si-7 LLC, where she shares her thoughtful perspectives on AI’s impact as a speaker and writer, and educator. She leads enterprise AI at US Foods.

Her experiences include leading innovative, emerging technology-enabled solutions, including traditional AI and GenAI, across healthcare and other industries. She has helped define transformed human experiences, while realizing business benefits.

Swarna also contributes to the AI discourse through her writing, with articles in CXOTech, PEX and on LinkedIn, examining business lessons and emerging trends in artificial intelligence.

Her co-authored articles for the American Stroke Association explore the meaningful intersection of technology and recovery, and how AI can help stroke survivors rebuild their sense of self.

She has most recently contributed to industry conversations on AI through speaking engagements at SSON Houston, Tampa Bay Tech and EX3 Labs led XR panel, where she shared insights on implementation approaches while acknowledging the complexities and ongoing learning inherent in this evolving field.

Over her 24+ years as a management consultant, corporate leader and entrepreneur, Swarna has grown a commitment to finding the balance between technological advancement and human-centered outcomes, continually seeking to understand how AI can serve human needs rather than technology for its own sake.

Swarna has a Master’s degree in Information Systems from Baylor University.

MUKUL PANDYA

Mukul is an Associate Fellow at Oxford University’s Saïd Business School and a consulting editor of Oxford Business Review. Mukul experienced a stroke in 2021 and was a guest author on our column with the American Stroke Association on his experience as a stroke survivor. 

He is the founding former editor-in-chief and executive director of Knowledge@Wharton (K@W), the web-based journal of research and business analysis published by the Wharton School of the University of Pennsylvania. He edited and managed K@W for more than 22 years until his retirement in 2020. In 2020-21. He was a Senior Fellow at the research centres Wharton AI for Business and Wharton Customer Analytics.

Mukul has won four awards for investigative journalism and has more than 40 years of experience as a writer and editor. His articles have appeared in The Wall Street JournalThe New York TimesThe EconomistTime magazine, The Philadelphia Inquirer and other publications.

He co-authored Lasting Leadership, Knowledge@Wharton on building corporate value and has written, co-authored or edited three other books. In 2020 he edited an award-winning book, Transformation in Times of Crisis, by Nitin Rakesh and Jerry Wind.

Mukul has a master’s degree in economics from the University of Bombay.