Research...

Focal Hand Dystonia | Results | Video Clips | Publications

October 2011 - Long-Term Follow-up Study on Focal Hand Dystonia
A 3-year follow-up study of the study published in December 2010 in Medical Problems of Performing Artists is on its way. Data collection was carried out in September and October, and statistical analysis will now take place. The aim of the study is to investigate the long-term effects of constraint-induced therapy and motor control retraining in musicians affected by focal hand dystonia.

Research 2007/2010 - Focal Hand Dystonia affecting musicians in Scotland - Now published in Medical Problems of Performing Artists, December 2010 issue - Vol.25: 149-161.
(click here)

Focal dystonia is characterised by an involuntary and painless task-specific loss of control of one or more digits of the hand. On this picture, the guitar player is unable to control his right ring finger. The finger tends to curl into the palm of the hand involuntarily.

Recent research in neurology has shown that the condition is associated with changes in areas of the brain involved with the control of movement, and especially distortions in the representational zones of the digits in an area of the somatosensory cortex. The reason for these neurological changes may be due to the highly repetitive and almost simultaneous finger movements that musicians have to practise.

Dystonia is a very difficult condition to treat successfully, and recovery is more often partial than complete. Many musicians affected by dystonia are unable to continue their professional career.

However, several treatment protocols exist, aiming at reversing these neurological changes taking place in the brain. Patrice has recently started a research study with a few bagpipers, two guitar players, two flute players, and an oboe player affected by focal hand dystonia. The study has been approved by the Ethics Committee at Glasgow Caledonian University, and data collection has now started.

His protocol involves a combination of sensory motor retuning (SMR), using splints to immobilise specific fingers (pictures below), and slow-down exercise therapy (SDE) in order to reinforce normal patterns of movement at slow speed. The musicians taking part will be monitored up to one year in order to evaluate their progress.

Results - Focal Hand Dystonia Research

Preliminary results of the Focal Hand Dystonia study, which has been ongoing since 2007, have been presented by Patrice at the Third International Conference on Movement Dysfunction (website), held in Edinburgh at the end of October 2009. These preliminary results involve a guitar player and a flute player. You can read the conference abstract here.

Final results of this study were presented at the 28th Annual Conference on "Medical Problems of Performing Artists", held in Snowmass, Colorado at the end of July 2010. You can read the conference abstract here.

This research study has now been published in the December 2010 issue of the medical journal Medical Problems of Performing Artists. To get the reference of the article, go to the publications list.

Video Clips - Focal Hand Dystonia Research

You can watch a series of video clips showing a guitar player:

sensory motor retuning (4MB),
playing before treatment (8MB),
playing after 6 months (8MB) of therapy,
playing after 12 months (8MB) of therapy.

Please note the tendency of the fourth finger to curl and the fifth finger to compensate by extending in the "before treatment" video clip. These movement patterns are greatly reduced after six months of sensory motor retuning. After 12 months, the guitar player can play the test piece with no visible dystonic pattern.

Publications

Berque P, Gray H, Harkness C, McFadyen A (2010) A Combination of Constraint-induced Therapy and Motor Control Retraining in the Treatment of Focal Hand Dystonia in Musicians. Medical Problems of Performing Artists. Vol.25: 149-161 (Journal Article - PDF 1MB) - Reproduced with kind permision of the publishers "Science and Medicine" (USA).
Berque P (2010) Physiotherapy and Dystonia - Hitting the Right Note.
Dystoniamatters! The Dystonia Society. Issue 70 - Winter 2010: 15-16.
Dystoniamatters! - Issue 70, Winter 2010 (PDF - 3MB).
Berque P, Gray H, Harkness C, McFadyen A (2009) A Combination of Constraint-Induced Therapy and Motor Control Retraining in the Treatment of Focal Hand Dystonia in Musicians - Case Studies of a Guitarist and Flautist. Manual Therapy. Vol.14 (Supplement 1): S18-S19.
Conference Abstract (PDF - 100KB).
Berque P, Gray H (2003) Influence de la douleur cou-epaule sur l’activite du muscle trapeze superieur chez des violonistes et altistes professionnels: une etude EMG. Medecine des Arts. Vol.43: 8-15.
Berque P (2003) Influence of Neck-Shoulder Pain on Trapezius Muscle Activity among Professional Violin and Viola Players. Physiotherapy.
Vol. 89: 126.
Berque P, Gray H (2002) The Influence of Neck-Shoulder Pain on Trapezius Muscle Activity among Professional Violin and Viola Players: An Electromyographic Study. Medical Problems of Performing Artists. Vol.17: 68-75.
Journal Article (PDF - 160KB) - Study on musculoskeletal pain carried out with musicians from Scottish Opera in 2002. Reproduced with kind permision of the publishers "Science and Medicine" (USA).

Conference Papers

Berque P, Gray H, Harkness C, McFadyen A (2010) A Combination of Constraint-Induced Therapy and Motor Control Retraining in the Treatment of Focal Hand Dystonia in Musicians. 28th Annual Symposium on Medical Problems of Performing Artists, Snowmass, Colorado, USA. Conference Abstract (PDF - 40KB).
Berque P, Gray H, Harkness C, McFadyen A (2009) A Combination of Constraint-Induced Therapy and Motor Control Retraining in the Treatment of Focal Hand Dystonia in Musicians - Case Studies of a Guitarist and Flautist. 3rd International Conference on Movement Dysfunction, Edinburgh ICC, UK. Conference Abstract (PDF - 100KB).
Berque P, Gray H (2003), The Influence of Neck-Shoulder Pain on Trapezius Muscle Activity among Professional Violin & Viola Players: an Electromyographic Study. 10th European Congress on Musician’s Medicine, Helsinki, Finland.
Berque P, Gray H (2002), The Influence of Neck-Shoulder Pain on Trapezius Muscle Activity among Professional Violin & Viola Players: an Electromyographic Study. CSP Congress, Birmingham ICC, UK.
Berque P, Gray H (2001) The Influence of Neck-Shoulder Pain on Trapezius Muscle Activity among Professional Violin & Viola Players: an Electromyographic Study. British Performing Arts Medicine Trust International Conference, Glasgow, UK