Constraint-induced movement therapy for focal hand dystonia in musicians

Abstract

splint) movement sequences and passages from their repertoire that had tended to generate dystonic movements in the past. All patients showed improvement without the splint at the end of treatment. The DES scores are given in the figure. The ratings on the scale range from: 0=dystonia as bad as at its worst, 1=slightly improved, 2=moderately improved, 3=almost normal, and 4=normal. A one-way analysis of variance followed by post-hoc Scheffe tests revealed that pretreatment scores were different from post-treatment (t[4]=5·2, p<0·01) and 1-month follow-up (t[4]=7·2, p<0·01) scores. The results on the DES were confirmed by the clinical evaluation of the treating neurologist and by the findings from the dexterity/displacement device obtained in the laboratory. The spectral power of the movements of the fingers of the dystonic hand in the band of the paced frequency showed an increase in the smoothness of those movements after treatment (p<0·01). After treatment, the one patient who was non-compliant regressed after 9 months; three patients showed additional improvement into the normal or almost normal range; and one showed no reduction in a substantial therapeutic effect. Two of the musicians have resumed concert performances.