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The cellist with focal or musician’s dystonia

This case study demonstrates how small integrative actions can the affect the disjuncture between desire and ability.

Emma is a professional cellist who described her fourth finger on her left hand as weak. She had tried various exercises to increase its strength, but it continued to inhibit her playing. I watched her playing and it was clear the finger was dystonic.

Dystonia is an imbalance of muscle firing (too much tone or too little) resulting in stiffening, involuntary movements, and inability to control the movements.Her finger was responding with reduced rapidity and visibly shaking while she tried to reach to press to the string.

Dr. Nancy Byl, PhD, PT, Professor and Chair of the Department of Physical Therapy and Rehabilitation Science at the University of California at San Francisco trained several monkeys to work for their supper by making them do repetitive hand movements. After several months they became increasingly reluctant to use their hands and showed signs of stiffness, clumsiness and pain. She believes that the monkeys lost their ability to identify which finger was which, that their brains were unable to make the distinction or map the fine finger action.

So it was with curiosity that I gave Emma a Functional Integration lesson, while she was sitting, her left hand in my hands. We explored the movement of her hand in various ways, including the detail of finding a way where each fingertip easily came to the thumb. More, it was finding out what action could be elicited through the nervous system to engage different organisation of the tiny joints, tendons, muscles and skin.



It’s rather like the Awareness Through Movement lesson "Surgeon’s Hands", but in Functional Integration format, and with only the one hand.

Byl subsequently developed the Practical Guidelines for Sensory and Selective Sensory Motor Training which have as the primary goal the restoration of the somatosensory representation of the hand and normal fine motor control.

Three main ways she recommends are:

  1. Identify everything about the surface of the instrument, eyes closed..
  2. reflect back to the time when the hand was working normally
  3. constantly remind [yourself] how easy it was to do the task, how warm the hand felt, how each individual digit felt absolutely controlled...and how coordinated the hand felt.

We did not specifically follow any of the actions suggested in Byl’s guidelines, but I suspect simply sitting in the context of playing the instrument, before and after, fulfilled them.

I’ll let Emma describe the result:

‘Margaret worked with me for only a short time, yet my finger, and my hand in general, feels massively stronger and somehow more whole. The subtlety of (the) work goes far deeper than any other treatment I have had. The difference to my playing is profound. I have more vigour in my hand, all fingers work evenly and, most importantly, I am now able to fully express my musical desires.’

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Tags: hands, focal dystonia, frozen shoulder, cerebral palsy, musicians, computer problems, repetitive strain