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A multifactorial conceptual model of peripheral neuromusculoskeletal predisposing factors in task-specific focal hand dystonia in musicians: etiologic and therapeutic implications

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Abstract

A model is presented showing how peripheral factors may cause a process of movement adaptation that leads to task-specific focal hand dystonia in musicians (FHDM). To acquire a playing technique, the hand must find effective and physiologically sustainable movements within a complex set of functional demands and anatomic, ergonomic, and physiological constraints. In doing so, individually discriminating constraints may become effective, such as limited anatomic independence of finger muscles/tendons, limited joint ranges of motion, or (subclinical) neuromusculoskeletal defects. These factors may, depending on the instrument-specific playing requirements, compromise or exclude functional playing movements. The controller (i.e., the brain) then needs to develop alternative motions to execute the task, which is called compensation. We hypothesize that, if this compensation process does not converge to physiologically sustainable muscle activation patterns that satisfy all constraints, compensation could increase indefinitely under the pressure of practice. Dystonic symptoms would become manifest when overcompensation occurs, resulting in motor patterns that fail in proper task execution. The model presented in this paper only concerns the compensatory processes preceding such overcompensations and does not aim to explain the nature of the dystonic motions themselves. While the model considers normal learning processes in the development of compensations, neurological predispositions could facilitate developing overcompensations or further abnormal motor programs. The model predicts that if peripheral factors are involved, FHDM symptoms would be preceded by long-term gradual changes in playing movements, which could be validated by prospective studies. Furthermore, the model implies that treatment success might be enhanced by addressing the conflict between peripheral factors and playing tasks before decompensating/retraining the affected movements.

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Notes

  1. For instance, as an indicator, we found the ratios of piano teachers to classical guitar teachers in six major schools of music worldwide ranging between 5:1 and 12:1.

Abbreviations

FHD:

Focal hand dystonia (not specific to musicians)

FHDM:

Focal hand dystonia in musicians

NFM:

Normally feasible movement

MC:

Movement compensation

RM:

Required instrumental movement

RoM:

Range of motion

DoF:

Degree of freedom

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Acknowledgments

The authors thank J. E. Bonte, MD, J. C. Van der Meulen, MD, PhD, J. M. F. Landsmeer, MD, PhD, C. W. Spoor, PhD, J. C. Snijders, PhD, A. B. M. Rietveld, MD, A. Gupta, MD, N. Campbell-Kyureghyan, PhD, P. M. Quesada, PhD, W. P. Hnat, PhD, G. Prater, PhD, P. Mathys, PhD, A. Delchambre, PhD, and F. Schuind, MD, PhD, for their support. This paper is part of the study ‘Anatomical variations predisposing to focal dystonia in the musicians’ hand’, supported by the Dystonia Medical Research Foundation, Chicago, IL (http://www.dystonia-foundation.org), the University of Louisville (IRIG-MRG grant), Louisville, KY, USA, and the Université Libre de Bruxelles, Brussels, Belgium. Dr. Hallett is supported by the NINDS Intramural Program.

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Authors and Affiliations

  1. Department of Bio-, Electro- and Mechanical Systems (BEAMS), Faculty of Applied Sciences, Université Libre de Bruxelles, Av. Fr. Roosevelt 50, 1050, Brussels, Belgium

    J. N. A. L. Leijnse

  2. Department of Orthopedics and Traumatology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium

    J. N. A. L. Leijnse

  3. Human Motor Control Section, Medical Neurology Branch, National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA

    M. Hallett

  4. Plastic and Hand Surgery, Bethesda Hospital, Hoogeveen, The Netherlands

    G. J. Sonneveld

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Correspondence to J. N. A. L. Leijnse.

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Leijnse, J.N.A.L., Hallett, M. & Sonneveld, G.J. A multifactorial conceptual model of peripheral neuromusculoskeletal predisposing factors in task-specific focal hand dystonia in musicians: etiologic and therapeutic implications. Biol Cybern 109, 109–123 (2015). https://doi.org/10.1007/s00422-014-0631-5

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