Practice makes perfect | Action Medical Research

Touching Lives - February 2007

Practice makes perfect

Occupational dystonia is a condition that can develop where certain types of repetitive movement cause involuntary muscle spasms of the hand. Between five and ten per cent of professional musicians suffer from it, but are often reluctant to talk publicly about the problem because of the impact it can have on their career.

There have been various studies into dystonia, but a £92,000 grant from Action Medical Research has helped fund a breakthrough in our understanding of the condition and potential therapies that can counter it.

Professor John Rothwell and Dr Karin Rosenkranz at the Institute of Neurology and National Hospital for Neurology and Neurosurgery in London, have been looking at what happens when longrepeated movements just seem to keep going wrong.

John says,”We have looked at healthy musicians from the Royal College of Music.They have played for hours every day since childhood and compared to non-musicians have a subtly different ‘wiring’ in the brain and a different way of organising the sensory signals sent from the fingers to the movement centres in the brain.

“We think that some musicians pay the price for over-specialisation and for some reason there is a disconnection between what the hands are feeling and how they are controlled. Movements repeated many, many times are permanently programmed into the brain in these skilled individuals but in people with dystonia, this organisation in the brain has gone too far.

“It is a complex process, but having seen what was happening in healthy musicians and in patients with dystonia we wanted to know if we could reverse the process.We have been experimenting with re-educating the brain using tiny vibrations to the fingertips, to reorganise the messages that go to the brain and control the hands. It seems it may work, and if so, we can tailor the technique to individual patients.

“In some initial experiments we have shown that short therapy sessions can retrain the brain back to normal, so if this technique was repeated over and over again we might get a permanent result.”

Although the study has centred on professional musicians, the findings potentially reach much further. Golfers, snooker players and anyone who has to repeat small, precise movements could suffer. There are many forms of dystonia, affecting thousands of people in the UK.

Concert pianist

Celebrated concert pianist and conductor Leon Fleisher first suffered occupational dystonia in his late thirties, when he should have been heading towards the pinnacle of his career. Twenty years after making his debut with the New York Philharmonic Orchestra, two fingers of his right hand became so badly affected by dystonia that he was forced to perfect a ‘left-handed repertoire’.

He became a distinguished teacher and conductor and was subsequently treated with injections of Botox — well known for its cosmetic effects and a recognised way of relaxing muscles, though its benefits are short term. Fleisher has recently made his first two-hand recording in 40 years called, appropriately, ‘Two Hands’.

Though many professional musicians are unwilling to discuss dystonia, there are a growing number of ‘blogs’ on the internet, where musicians can share the problems they face. Violinists from around the world have a lively discussion board offering advice on dystonia. Symptoms reported by them include an involuntarily curling of the fingers and tremors of the hand, which can make playing impossible.

John adds, “This study would not have been possible without the funding from Action Medical Research. This field of neurology is very specialised and we are grateful for the help we have received. We certainly now have a better understanding of the problem, a good insight into what happens in a musician’s brain and how it can be retrained.” TL

Professor Rothwell has since been awarded a further grant to study other forms of dystonia. More details can be found on page 14.

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