Slow-Down Exercise for the Treatment of Focal Hand Dystonia in Pianists

Abstract

Twenty professional pianists (10 males, 10 females; average age, 30.0 yrs) with focal hand dystonia were treated through slow-down exercise (SDE) therapy with successful results. SDE consisted of 5 steps: (1) The patients chose the musical piece which causes a dystonic hand movement. (2) Patients reduced the performance speed until the dystonic hand movement disappeared, and they recorded the slowed speed with a metronome. (3) At the slowed rate, patients repeatedly rehearsed the musical piece for 0.5 hr/day for 2 weeks. Other than the SDE, they were allowed to practice playing the piano freely. (4) After 2 weeks, patients attempted to increase their speed from 10% to 20%. If symptoms did not appear under the increased movement speed, patients proceeded to increase the speed of practice for an additional 2 weeks. If the dystonic motion appeared under the increased speed, patients returned to the slower speed of movement. (5) After 2 weeks, Step 4 was repeated and the performance speed was gradually increased. The performance speed was decreased by an average of 12.4 % of normal. Clinical results evaluated by the Arm Dystonia Disability Scale (ADDS) indicated that prior to performing the SDE, 4 subjects experienced moderate difficulty (ADDS = 2) and 16 subjects had marked difficulty (ADDS = 3). However, after SDE therapy, symptoms improved to normal (ADDS = 0) in 12 subjects and to mild (ADDS = 1) in 8 subjects. Clinical results evaluated by the Tubiana and Chamagne Score (TCS) showed significant (p < 0.05) improvement from 2.2 ± 0.41 to 4.6 ± 0.50.