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pianomap : Dystonia

Dystonia is distinct from injuries like tendonitis that affect muscles and tendons. In dystonia the brain's capacity to control movement is impaired. Muscles may tighten involuntarily, producing awkward, jerky movements. Hands or fingers may fail to respond to conscious commands, or respond in unintended ways. Fingers may clench involuntarily instead of touching the intended key. The condition may not be painful, but the emotional stress and frustration endured by musicians suffering from dystonia is immense. Dystonia has ended the careers of some famous and wonderful musicians.

Dystonia can affect any part of the body, and it takes many forms. Some dystonias are devastating conditions that affect large areas of the body, distort posture and speech, make driving, walking, talking or eating difficult or impossible. Some dystonias seem to be congenital, perhaps genetic. The cause of these conditions is not well understood, nor is there any reliable cure.

Other forms of dystonia are not congenital but appear later in life. Acquired dystonia often affects only a specific part of the body, perhaps just one finger, which may uncontrollably clench or freeze or shoot out to the side. Dystonia of this sort is called "focal dystonia" and it is the sort that most often occurs in pianists. Focal dystonia usually affects parts of the body that are subject to constant use in an activity like writing or piano playing. Sometimes the affected part, a finger, for example, responds normally in other activities and becomes uncontrollable only in the context of the specific activity of writing or piano playing.

The cause of focal dystonia is not precisely known. No one, I believe, is yet in a position to state the necessary and sufficient conditions for the development of focal dystonia, nor to say exactly what neurological events occur or fail to occur when a pianist loses control of her fingers. Moreover, there is no medical cure for dystonia-none, that is, that counts as a cure in the way penicillin is a cure for strep infection, where the cure is reliable, we know why it works and we can explain those cases when it doesn't work. In the sense of "cure" according to which a doctor administers the cure and the patient is well again, there is no cure for dystonia.

Nevertheless, the situation is not hopeless for pianists or other musicians with focal dystonia. There are many musicians who have recovered from dystonia and returned to full playing. There may be no medical cure for dystonia, but there are movement therapies that have been consistently successful in cases of musicians' focal dystonia. The successful therapies start from an empirically observed connection between dystonia and certain patterns of movement. When a person changes those patterns, the condition can eventually resolve. Admittedly, this is a delicate process. It requires consistency, vigilant attention, and time. Some forms of movement retraining are more effective than others. Concentrating on technique alone is not always effective; there are pianists who have undertaken to cure their dystonia by re-building their technique but made little progress after lengthy (and expensive) training. Approaching the problem from the point of view of overall coordination of the whole body, in the manner of Andover Educators' founder Barbara Conable, is generally more successful than concentrating on training just the hand and fingers. No one knows for certain whether her approach will help all musicians with dystonia, but it has been consistently successful with those who have followed it. One thing that seems clear is that developing a sense of embodiment, training the kinesthetic sense, acquiring an accurate and adequate body map and constantly relating the part to the whole are vital in the resolution of dystonia.

Why movement retraining is effective in cases of dystonia is a matter for further research. It is tempting to guess that what must happen is to re-educate the brain-hand relationship. Perhaps it is a matter of creating new nervous pathways that will reliably transmit the commands from the brain to the fingers and send information back from the fingers to the brain. For musicians, the final answer on those questions is less important than the fact that recovery from dystonia is possible.

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