Musician’s Dystonia

Dystonia is a neurological disorder characterized by involuntary muscle contractions, abnormal postures and movements, tremors and sometimes pain. Focal task-specific dystonia (FTSD) refers to dystonia that affects an arm or leg and typically presents as task-specific muscle spasms or “occupational cramps” in which learned or repetitive motor tasks trigger muscle spasms. These interfere with specific tasks while other actions remain normal. Writer’s cramp is the most common form of FTSD.

Guitar DystoniaPlaying a musical instrument also can trigger muscle spasms or tremors that interfere with musical performance, while other everyday actions are not affected. Musicians are particularly prone to FTSD due to their intense trainng and years of executing complex and repetitive movements. While FTSD is not common in the general population (1 in 3,400), a conservative estimate puts the number of musicians affected at 1 in 200. The true figure may be higher as musicians are often reluctant to seek help. Great pianists such as Robert Schumann in the 19th century, and contemporary performers Gary Graffman and Leon Fleisher, have suffered from FTSD that has radically altered their performing careers. Virtually any instrumentalist may get FTSD. It is often unrecognized, and musicians may learn of the disorder after many years of symptoms.

Music_pic3aTo study FTSD in musicians in more detail, we have developed Music Notation Analysis, a method for objectively quantifying critical aspects of music performance using electronic musical instruments, a digital interface and special analysis software. Music Notation Analysis provides a level of accuracy and refinement in addition to what currently is obtainable through clinical examination or subjective assessment. The program detects and analyzes data on note selection, playing speed and accuracy, timing, rhythm, and loudness. An analysis of error is also created based on both performance consistency and comparisons with templates. The analyses also can be applied to study details of normal musical performance and quantify development with practice and learning.

Piano Dystonia2As part of a study investigating the effects of botulinum toxin (BTx) injections as a treatment for dystonia, musicians with FTSD are evaluated using Music Notation Analysis before and after treatment with BTx. They play scales and arpeggios, as well as self-identified passages that highlight their most troublesome symptoms. Multiple repetitions of each passage are recorded and transcribed through a sequencing program and a musical instrument digital interface (MIDI), after which we use Music Notation Analysis to study BTx treatment effects.

Music notation analysis is applied over multiple sessions and is used to evaluate the overall efficacy of BTx treatment both quantitatively and in comparison with the musicians’ subjective impressions about performance. Additionally, because patients return for BTx injections roughly once every three months, we are also able to evaluate the success of small changes in BTx injection patterns over multiple treatment visits.

Currently our Music Notation Analysis setup allows us to test musicians who can perform on electronic versions of the piano or guitar. In the future, we will expand to include the digital analyses of additional instruments. The restriction to specific instruments applies only to the Music Notation Analysis research. Our clinical evaluation and treatment of FTSD in musicians has no such limitations. We treat all varieties of musicians including banjo players, drummers, violinists, clarinetists, flutists, trumpet players and bagpipers, in addition to guitar players and pianists.