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Long-Term Outcome of Focal Dystonia in Instrumental Musicians

 
 

Copyright 2017, Mark Alan Wade

Primary Author: Schuele, S.
Journal Title: Advances in Neurology, Dystonia 4
Date Published: 2004
Language: English
Category: Nervous Disorders
Key Words: treatment performance musician instrumental focal dystonia
Full Citation: Schuele, S. U., and R. J. Lederman. Long-Term Outcome of Focal Dystonia in Instrumental Musicians. Advances in Neurology 94 Dystonia 4, no. 36 (2004): 261-6.
Full Abstract: Forty-five bowed string and woodwind instrumentalists with a diagnosis of focal dystonia were seen between 1985 and 2001 at the Medical Center for Performing Artists, Cleveland Ohio. Among the string players, eighteen were men and three women. The mean age at onset of the symptoms was thirty-four years; the median age was thirty-one years. Among the woodwind instrumentalists, there were fifteen men and nine women. The mean age of onset of symptoms here was thirty-four; the median age was 32.5 years. Overall, there is evidence for increased risk of focal dystonia among men. Treatments employed by the patients included: abstinence from playing, physical exercise, biofeedback, psychotherapy, body awareness technique, alteration in playing technique, change of instrument, new teacher, slow practice/relearning, medication (anticholinergic, dopaminergic, other), surgery (nerve entrapment), Botulinum toxin, splinting/immobilization, and sensory motor retuning/constraint-induced therapy. For all options of treatment, the results varied from none to moderate improvement. Only five of eleven patients with hand dystonia were able to continue their careers as professional musicians. Five of fourteen professional performing string players were able to remain performers. The rest either changed careers entirely, or began teaching full-time. New treatment options with possible anecdotal success need to be studied: refingering exercises, rebuilding the embouchure, and splint devices with prolonged immobilization for four to five weeks.