Abstract--Twenty professional pianists (10 males, 10 females; average age, 30.0 yrs) with focal hand dystonia were treated through slow-down exercise (SDE) therapy with successful results. SDE consisted of 5 steps: (1) The patients chose the musical piece which causes a dystonic hand movement. (2) Patients reduced the performance speed until the dystonic hand movement disappeared, and they recorded the slowed speed with a metronome. (3) At the slowed rate, patients repeatedly rehearsed the musical piece for 0.5 hr/day for 2 weeks. Other than the SDE, they were allowed to practice playing the piano freely. (4) After 2 weeks, patients attempted to increase their speed from 10% to 20%. If symptoms did not appear under the increased movement speed, patients proceeded to increase the speed of practice for an additional 2 weeks. If the dystonic motion appeared under the increased speed, patients returned to the slower speed of movement. (5) After 2 weeks, Step 4 was repeated and the performance speed was gradually increased. The performance speed was decreased by an average of 12.4 % of normal. Clinical results evaluated by the Arm Dystonia Disability Scale (ADDS) indicated that prior to performing the SDE, 4 subjects experienced moderate difficulty (ADDS = 2) and 16 subjects had marked difficulty (ADDS = 3). However, after SDE therapy, symptoms improved to normal (ADDS = 0) in 12 subjects and to mild (ADDS = 1) in 8 subjects. Clinical results evaluated by the Tubiana and Chamagne Score (TCS) showed significant (p < 0.05) improvement from 2.2 [+ or -] 0.41 to 4.6 [+ or -] 0.50.
Focal dystonia is difficult disease to treat, especially focal hand dystonia, which can cause serious problems in occupational workers such as writers, typists, and musicians. The cause of this disease is unknown, and it may interrupt professional careers.
Recent reports have focused on the focal dystonia, or hand cramps, that occurs in musicians, such as pianist's cramp and guitarist's cramp. (1-3) A large number of occupational muscle cramps are extremely difficult to treat, and it is often necessary for affected persons to abandon their occupational career. Such is the case with musician's cramp, and thus it is a serious problem for musicians. At the first International Congress of Musician's Medicine, held in Turku, Finland, in 2003, 1 entire day was allotted for the theme of focal dystonia during the 4-day meeting. (4)
Treatments for musician's focal dystonia also have been reported in literature. Lederman (5) attempted unsuccessfully to treat the condition through administration of primarily anticholinergic medications, in addition to administering physical therapy (including relaxation techniques), occupational therapy, and psychotherapy. He found that only botulinum toxin was effective to any extent. However, the treatment efficacy of botulinum toxin was not as promising for musician's focal dystonia as it was for other types of focal dystonia, and a combination of re-education and retraining lasting 1 year or longer was suggested to be necessary. (5)
Candia et al. (6) used splints to immobilize one or more digits other than the focal...
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