The role of retraining in rehabilitation from focal dystonia

Focal dystonia is a debilitating movement disorder which occurs as a result of many repetitions of a specific task and typically manifests in involuntary muscle contractions. In pianists, an incoordination occurs between fingers, making it impossible to play at concert level. Three pianists with focal hand dystonia participated in a retraining program based on a biomechanically sound way of playing with minimal tension. Quality of scales and repertoire were assessed before and after pianism retraining by several rating systems and included assessment by a listener blinded as to which hand was dystonic and whether they were assessing playing preor post-retraining. Scale quality improved with retraining in all three pianists, with improvement in both hands, but greater in the dystonic hand. While there was no change in the blinded listener being able to identify the non-dystonic hand from pre-training to post-training, they could correctly identify the dystonic hand 79% preretraining, but this decreased to 28% post-retraining. The test repertoire evaluation and the visual evaluation rating were shown to improve significantly by 1.0 and 1.3 points, respectively (on a five point rating scale), from pre-training to post-training.