Focal Dystonia in Pianists: A Way To Recovery Through Retraining

Abstract

Focal dystonia is a movement disorder resulting from many repetitions of a specific task, typically manifesting as involuntary muscle contractions. In pianists an incoordination occurs between fingers, making it impossible to play at concert level. A blurring occurs in the cerebral cortex of the neural pathways which govern the independent movement of adjacent fingers. Prognosis is poor, and as it is essential for any pianist to have independence of each finger, most sufferers are forced to abandon their careers. The aim of this research was to ascertain whether by remodelling a pianist’s technique and modifying habitual movement patterns, pianists with focal dystonia would be able to play again at their former level. The methodology employed in this research is novel in that it combines pedagogical method with scientific method, without other medical intervention. Three pianists with focal dystonia participated in an initial retraining programme based on a biomechanically sound way of playing with minimal tension. Scale playing and repertoire that was difficult because of the dystonia were recorded on video before and after a two-week period of retraining. Recorded excerpts were assessed by a professional pianist (Blinded Listener), blinded as to which hand was dystonic and whether the playing was pre- or post-retraining. The sound only of different scales was assessed using a Scale-Quality Evaluation (SQE), and a Dystonic Hand Identification Evaluation (DHIE), where the listener was asked to identify whether the scale was played by a dystonic hand or not. Test-Repertoire segments (TR) were assessed musically and visually, and compared with playing prior to the onset of dystonia. Scale Quality improved with retraining (p<0.0001) in all three pianists in not only the dystonic hand but the nondystonic as well, regardless of tempo and key of the scale. Post-retraining, the Blinded Listener was no longer able to reliably identify the dystonic hand (p<0.0001). Test Repertoire also showed significant improvement (p<0.0001). Following this initial study the research was further extended with three more subjects, presented as case studies: two pianists and a cellist. A similar methodology was used with the first severely affected pianist, but using intensive training of five hours per day for two weeks. Her SQE also improved significantly (p<0.0001) and also her DHIE (p<0.0001). The study with the second pianist was done via the medium of video conferencing. Although less successful, the improvement was still statistically significant (p<0.01), showing the possibility of assisting recovery from focal dystonia through distance retraining. The final case study explored the relevance of using similar methodology with a different instrument, the cello. The affected cellist had a dystonic vibrato which improved significantly with retraining (p<0.0001). In summary, these data show that by establishing biomechanically ideal movement patterns, retraining can successfully improve the symptoms of focal dystonia in pianists, and that this approach may be transferable to other instruments.