Changing the Brain through Therapy for Musicians Hand Dystonia

Focal hand dystonia is a disorder in which sensory and motor anomalies emerge that appear to be grounded in maladaptive routes of cortical plasticity. Remodeling cortical networks through sensory-motor retuning (SMR), we achieved long-term reduction in the symptoms of focal hand dystonia. Magnetoencephalography confirmed that SMR modified the representational cortex of the fingers, whereby the representation of the affected hand was reorganized so that it resembled more the organization of the non-affected side. Furthermore, we observed differences in abnormal tactile acuity between patients with musician s cramp and those with writer s cramp: Using twopoint finger discrimination, dystonic musicians showed perceptual asymmetry between hands, while writer s cramp patients did not. To further evaluate the occurrence of collateral disturbances in focal dystonia, we assessed the clinical histories of 101 affected musicians. An important finding from this study was that dystonic musicians who play a similar first and second instrument reported a continuous worsening of their symptoms. In addition, collateral disturbances appeared with a shorter delay when more than one instrument was played. Taken together, these studies suggest that (1) neurological dysfunction can be reversed by context-specific training protocols, (2) specific symptomatic and etiological differences among various forms of focal hand dystonia might result from different behavioral experiences and their central representation, and (3) the spread of symptoms might be prevented by avoiding training that implies movement patterns similar to the main affected task, and by reducing the amount of task-associated movement behavior

Eufonía : didáctica de la música

Resumen basado en el de la publicaciónTítulo, resumen y palabras clave en español e inglésSe realiza una valoración de un nuevo enfoque en la formación y promoción de la salud en conservatorios y escuelas de música. La experiencia se está llevando a cabo en el Conservatori Municipal de Música J.M.ª Ruera de Granollers. Las acciones del proyecto se desarrollan a través de tres niveles: asignaturas de educación corporal para el alumnado, sesiones formativas para el profesorado y tutorías entre el profesor, el alumno y un experto en el problema presentado por el alumno. Se analizan los resultados de los dos primeros años de trabajo y se platean posibles acciones futuras.Biblioteca de Educación del Ministerio de Educación y Formación Profesional; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

Work-related pain in extrinsic finger extensor musculature of instrumentalists is associated with intracellular pH compartmentation during exercise.

BACKGROUND: Although non-specific pain in the upper limb muscles of workers engaged in mild repetitive tasks is a common occupational health problem, much is unknown about the associated structural and biochemical changes. In this study, we compared the muscle energy metabolism of the extrinsic finger extensor musculature in instrumentalists suffering from work-related pain with that of healthy control instrumentalists using non-invasive phosphorus magnetic resonance spectroscopy ((31)P-MRS). We hypothesize that the affected muscles will show alterations related with an impaired energy metabolism. METHODOLOGY/PRINCIPAL FINDINGS: We studied 19 volunteer instrumentalists (11 subjects with work-related pain affecting the extrinsic finger extensor musculature and 8 healthy controls). We used (31)P-MRS to find deviations from the expected metabolic response to exercise in phosphocreatine (PCr), inorganic phosphate (Pi), Pi/PCr ratio and intracellular pH kinetics. We observed a reduced finger extensor exercise tolerance in instrumentalists with myalgia, an intracellular pH compartmentation in the form of neutral and acid compartments, as detected by Pi peak splitting in (31)P-MRS spectra, predominantly in myalgic muscles, and a strong association of this pattern with the condition. CONCLUSIONS/SIGNIFICANCE: Work-related pain in the finger extrinsic extensor muscles is associated with intracellular pH compartmentation during exercise, non-invasively detectable by (31)P-MRS and consistent with the simultaneous energy production by oxidative metabolism and glycolysis. We speculate that a deficit in energy production by oxidative pathways may exist in the affected muscles. Two possible explanations for this would be the partial and/or local reduction of blood supply and the reduction of the muscle oxidative capacity itself

Descriptive data of subjects included in the study.

<p>Values are mean ± SD. CSA; cross-sectional area. There were no significant differences between patient and control groups in either dominant or non-dominant arms.</p>*<p>Significant differences: dominant vs. non-dominant arm, paired data Student-t test, p<0.001. Instrumentalists by instrument (controls/patients): Piano (3/5), Guitar (2/0), Electric guitar (1/2), Saxophone (1/1), Clarinet (1/1), Double bass (0/1), Drums (0/1).</p

Determination of the utility of near-infrared spectroscopy in the study of exertional myalgia and chronic exertional compartment syndrome in musicians’ forearms

<p>The non-invasive and real-time near-infrared spectrometry (NIRS) has been proven to distinguish<br>between individuals with chronic exertional compartment syndrome (CECS) and healthy individuals based on a significantly lower tissue oxygenation index (TOI) or tissue saturation index (TSI), during exercise provocation. The use of abnormal Intracompartmental pressure values remain as the most solid method to diagnose individuals as CECS. However, supposedly healthy individuals with CECS-like criteria in terms of abnormal ICP values are harder to distinguish and require further looking into each patient's medical history. In addition, as the nature of the method is quite prone to cause discomfort in subjects and is not risk-free, an alternative methodology that causes less discomfort and is less time consuming may be preferable. Our results reinforce the real-time NIRS measurement as being a fair non-invasive replacement for direct ICP measure to detect CECS indirectly, focusing on the TOI trace.</p

Representative time courses of metabolite raw amplitudes, intracellular pHs, and total Pi/PCr ratios during exercise.

<p>A, MRS pattern A; B, MRS pattern B; PCr, phosphocreatine; Pi, inorganic phosphate (N-Pi, neutral-pH peak; L-Pi, low-pH peak). Data were obtained from 64 s spectra and the displayed symbol times are the centre point of the time periods.</p

Representative ³¹P spectra of the finger extensor muscles at rest and during exercise.

<p>A, MRS pattern A (control); B, MRS pattern B (patient). Peak assignments: ATP, adenosine triphosphate; PCr, phosphocreatine; Pi, inorganic phosphate (N-Pi, neutral-pH peak; L-Pi, low-pH peak). The spectra are the sum of 32 scans (64 s) The displayed spectra times are the centre points of such time periods. Note the appearance of a second and acidic Pi peak (L-Pi) in pattern B spectra. Exercise in the chosen example of pattern A was performed for a longer time period without Pi splitting, but only the same time points as in pattern B example are shown for comparison purposes.</p