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A traditional way to play the instrument is to lay it flat on the lap and pluck or strum the strings with one hand, while fretting with the other. In practice, a wide variety of playing styles are used.
When four strings are used, the first 2 strings are placed close together and tuned the same. This can be used to emphasize the melody, while the other two strings are used as drone strings.
The frets of the Appalachian dulcimer are arranged in a diatonic scale.
It is widely used in the American Old-time music tradition. This instrument first appeared in the early 1800s in the southern Appalachian Mountains, and is thus also called a mountain dulcimer.