Abstract--Focal dystonia is a debilitating movement disorder that occurs from many repetitions of a specific task. It typically manifests in involuntary muscle contractions and, in pianists, causes an incoordination between fingers, making it impossible to play at concert level. Prognosis is poor, and most sufferers are forced to abandon their careers. The aim of this research was to ascertain whether pianism retraining would enable pianists affected by focal hand dystonia to play again. Three pianists with focal hand dystonia participated in a retraining programme based on a biomechanically sound way of playing with minimal tension. Quality of scales and repertoire were assessed before and after pianism retraining by several rating systems, which included assessment by a listener blinded as to which hand was dystonic and whether the playing was pre- or postretraining. Scale quality improved with retraining (p < 0.0001) in all three pianists, with improvement in both hands but greater improvement in the dystonic hand. Although there was no change in the blinded listener's ability to identify the nondystonic hand from pre-retraining to post-retraining, they could correctly identify the dystonic hand 79% of the time pre-retraining, but this decreased to 28% post-retraining. The test repertoire evaluation and the visual evaluation rating were shown to improve significantly by 1.0 and 1.3 points, respectively (on a five-point rating system), from pre-retraining to post-retraining (p < 0.0001). Our data show that pianism retraining can improve the symptoms of focal dystonia in pianists.
Developing the skill required to play a musical instrument is one of the most neurologically demanding learning tasks. The musician is required to acquire high speed control of repetitive complex movement patterns, while responding to auditory feedback and engaging in the emotional connection required to make music. (1)
Since the advent of the recording industry, the demands on the musician for total accuracy, while taking the risks required to bring a performance to life, have escalated. There is the perceived need for more and more practice to achieve the perfectionism in a live performance that compares with the standards of a compact disc recording. (2)
Unless the body maintains movement patterns that are biomechanically sound, the musician is at risk of injury. (3,4) A devastating example of this is focal dystonia. Unlike occupational overuse syndrome, focal dystonia is usually a painless condition that manifests itself in an incoordination or cramping (involuntary flexion) of the fingers, making the high level of control required for concert performance impossible. (2,3) It is task specific (3,5) and generally does not influence other unrelated activities. In pianists, it affects the ability to play scales, trills, or passages of 16th notes evenly, and sometimes extraneous notes sound with octaves or chords. It has devastating consequences for a musician, as it threatens the identity of the sufferer and usually results in the end of a performing career. (5)
The first recorded description of this condition in a pianist is in the diaries of Robert Schumann in 1830, who reported problems with lack of control and involuntary flexion...
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