Focal Dystonia in musicians: from phenomenology to therapy

Reference

Jabusch, H.C., Altenmueller, E. (2006)
Focal Dystonia in musicians: from phenomenology to therapy.
Advances in Cognitive Psychology, 2(2-3), 207-220.

Summary
This study of focal dystonia was conducted at Institute of Music Physiology and Musicians’ Medicine, University of Music and Drama in Hanover, Germany and collected symptoms and treatment results from 144 professional musicians who were diagnosed with focal dystonia between 1994 and 2001.
Focal dystonia is a task-specific movement disorder which manifests itself as a loss of voluntary motor control in extensively trained movements. One in a hundred professional musicians are affected, approximately.
An overview of the causes, physiological and neurological manifestion, and possible treatments are presented in this article.
So far, the causes of focal dystonia are attributed to excessive repetition of fine-motor skill movements in instrumental practice with psychological condition of perfectionism and anxiety and possibly, hereditary traits. Its manifestation in the brain map shows alteration in the basal ganglia circuitry and dysfunction plasticity in the sensory thalamus, as well as abnormal cortical processing of sensory information, degraded representation of motor function, and decreased cortical inhibition.
These patients were divided into groups and underwent two categories of therapies:
1. medical
- medication with Trihexyphenidyl
- injection therapy with Botulinum Toxin
2. behavioural
- ergonomic changes
- pedagogical retraining
- non-specific exercises on the instrument
The long-term result of behavioural therapies showed a higher rate of improvement in the patients than that of medical therapies. The future goal of researchers in this field is not only to search for cures, but also to discover effective strategies for preventing this disorder in developing musicians.

Review & Reflection
Since focal dystonia is mostly practice-induced, it corresponds with the higher positive feedbacks from behavioural treatment for this disorder. It is encouraging to witness evidences of brain plasticity in this field because it shows possibilities of training ourselves in and out of this disorder. Active involvement in the behavioural treatment shows a better result than passive reception of medical/chemical treatment. Also, it supports the idea of curing oneself from inside out with one's own conscious action.
Future research into awareness of instrumental practice patterns and improvement in practice routines will benefit not only professional musicians, but also growing performers in their development of a healthy and lifelong musical journey. There are few experiences more disencouraging than being prevented from making music by physical disorders. On the other hand, collaboration with music performers and pedagogues can give researchers more practical applications in preventing focal dystonia in the education of future musicians.