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A Case Report: Using Multimodalities to Examine a Professional Pianist with Focal Dystonia

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Perspectives in Performing Arts Medicine Practice

Abstract

Task-specific dystonia is characterized by excessive muscle contractions producing abnormal postures. These structural and functional changes are known to be a result of maladaptive neuroplasticity to prolonged, intense, repetitive movement. While some factors of neuropathology of focal dystonia are known, the etiology of task-induced focal dystonia and effective treatments are unknown. We examined hand biomechanics, neurophysiology, and music performance outcomes in a 53-year-old male pianist with dystonic extension of the left third digit while playing the piano. We aimed to gain information that can help develop a holistic rehabilitation strategy. The pianist led a life with constricted work patterns leaving little time to recharge or relax. He had large hands with a hypermobile structure. Music Instrument Digital Interface (MIDI) data showed the lack of fine digital touch control required for skilled music playing. Functional magnetic resonance imaging (fMRI) demonstrated enhanced activity in contralateral primary sensorimotor cortex, supplementary motor area, and parietal-occipital regions during simulated left-hand scale playing. Intramuscular needle EMG analysis demonstrated hyperactivation of the left extensor digitorum communis (EDC) with a distinct periodic oscillatory pattern during and persisting after playing, which was not as prominent in the unaffected extensor indicis proprius (EIP), thus demonstrating that pianist’s focal dystonia was associated with increased activity in the contralateral motor cortex area and a distinct oscillatory EMG activity. Video recording of retraining sessions using a vibrotactile sensor showed progress. A complete recovery of the affected finger deficit remains elusive after the 8-week retraining.

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Acknowledgments

We appreciate USF Neuroscience Collaborative Seed Grant (2010–2012) and USF Office of Research and Innovation Early Career Researcher Grant (2015) that enabled this study and 30 other pianists’ hand studies.

We appreciate our subject pianist’s cooperation in this experiment.

We are thankful to Dr. Robert Belsole for his careful examination of our pianist’ hand.

We thank Jeff Chodil for his assistance with data management.

Additional Information

Financial disclosure/conflict of interest concerning the research related to the manuscript: There is no conflict of interest.

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Authors and Affiliations

  1. School of Music, College of the Arts, University of South Florida, Tampa, FL, USA

    Sang-Hie Lee

  2. Department of Neurology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Juan Sanchez-Ramos, Ryan Murtagh & Tuan Vu

  3. School of Physical Therapy & Rehabilitation Sciences, Morsani College of Medicine, University of South Florida, Tampa, FL, USA

    Dustin Hardwick

  4. Department of Mechanical Engineering, Center for Assistive, Rehabilitation & Robotics Technologies (CARRT), University of South Florida, Tampa, FL, USA

    Stephanie L. Carey

Authors
  1. Sang-Hie Lee
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  2. Juan Sanchez-Ramos
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  3. Ryan Murtagh
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  4. Tuan Vu
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  5. Dustin Hardwick
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  6. Stephanie L. Carey
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Corresponding author

Correspondence to Sang-Hie Lee .

Editor information

Editors and Affiliations

  1. University of South Florida, Tampa, FL, USA

    Sang-Hie Lee

  2. University of South Florida, Tampa, FL, USA

    Merry Lynn Morris

  3. University of South Florida, Tampa, FL, USA

    Santo V. Nicosia

Electronic Supplementary Material

Rehab sessions of pianist with focal dystonia on the left middle digit (MP4 215446 kb)

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Lee, SH., Sanchez-Ramos, J., Murtagh, R., Vu, T., Hardwick, D., Carey, S.L. (2020). A Case Report: Using Multimodalities to Examine a Professional Pianist with Focal Dystonia. In: Lee, SH., Morris, M.L., Nicosia, S.V. (eds) Perspectives in Performing Arts Medicine Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-37480-8_11

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  • DOI: https://doi.org/10.1007/978-3-030-37480-8_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-37479-2

  • Online ISBN: 978-3-030-37480-8

  • eBook Packages: MedicineMedicine (R0)

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