Sensory–motor rehabilitation therapy for task-specific focal hand dystonia: A feasibility study

Abstract

Introduction

Medical treatments have limited long-term effect in task-specific dystonia. Whilst evidence supports the use of rehabilitation, no randomised controlled trials have been undertaken. This small-scale study determined the feasibility of implementing and evaluating a mixed sensory–motor task-specific dystonia rehabilitative programme.

Methods

Participants with writer’s or musician’s dystonia were recruited from a movement disorder and hand therapy clinic. Feasibility measures were recruitment rate, retention, session attendance, adherence to exercises. Self-report measures at 0, 3 and 6 months included: Arm Dystonia Disability Scale (ADDS), Tubiana and Chamagne Scale (TCS), Brief Illness Perception Questionnaire (BIPQ), Health Status (EQ-5D 5L), Clinical Global Impression Scale (CGI). Task performance was video-recorded at baseline and 6 months. At 6 months, interviews explored participant experiences of the intervention.

Results

Fifteen patients were recruited over 6 months (rate 2.5/month, musician’s dystonia = 8, writer’s dystonia = 7). Complete data sets were collected for twelve people(80%). The programme comprised a maximum six sessions plus daily home exercises. Nine completed the home programme at ≥75%. No adverse events were reported. Effect sizes at 3 and 6 months, respectively, were ADDS 3-month = 0.28, 6-month = 0.23; TCS 3-month = 0.13, 6-month = 0.53; BIPQ 3-month = 0.38, 6-month = 0.71; EQ-5D-5L 3-month = 0.34, 6-month = 0.59; video analysis at 6 months = 0.78. Eleven (92%) improved on the CGI. Interviews supported acceptability of the intervention.

Conclusions

This intervention was feasible to deliver with high retention, adherence and acceptability. Improvements occurred across measures. This informs the development of future randomised controlled trials.

Keywords

Musicians’ dystonia writers’ dystonia sensory–motor rehabilitation therapy hand therapy

Get full access to this article

View all access options for this article.

References

Peterson

Berque

Jabusch

H-C

et al . Rating scales for musicians’ dystonia. Neurology 2013; 81: 589–598.

Sadnicka

Kassavetis

Parees

et al . Task-specific dystonia: pathophysiology and management. J Neurol Neurosurg Psychiatry 2016; 87: 968–974.

Karp

Cole

Cohen

et al . Long-term botulinum toxin treatment of focal hand dystonia. Neurology 1994; 44: 70–76.

Byl

Merzenich

and Jenkins

WM.

A primate genesis model of focal dystonia and repetitive strain injury: I. Learning induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys. Neurology 1996; 47: 508–520.

Byl

Wilson

Merzenich

et al . Sensory dysfunction associated with repetitive strain injuries of tendonitis and focal hand dystonia: a comparative study. J Orthop Sports Phys Ther 1996; 23: 234–244.

Byl

and McKenzie

Treatment effectiveness for patients with a history of repetitive hand use and focal hand dystonia: a planned, prospective follow-up study. J Hand Ther 2000; 13: 289–299.

Byl

McKenzie

and Nagarajan

SS.

Differences in somatosensory hand organization in a healthy flutist and a flutist with focal hand dystonia: a case report. J Hand Ther 2000; 13: 302–309.

Byl

and Topp

KS.

Focal hand dystonia. Phys Ther Case Rep 1998; 1: 39–52.

Taub

Miller

Novack

et al . Technique to improve chronic deficit after stroke. Arch Phys Med Rehabil 1993; 74: 347–354.

10.

Taub

Uswatte

and Pidikiti

Constraint-induced movement therapy: a new family of techniques with broad application to physical rehabilitation - a clinical review. J Rehabil Res Dev 1999; 36: 1–21.

11.

Candia

Elbert

Altenmüller

et al . Constraint-induced movement therapy for focal hand dystonia in musicians. Lancet 1999; 353: 42.

12.

Candia

Schafer

Taub

et al . Sensory motor retuning: a behavioural treatment for focal hand dystonia of pianists and guitarists. Arch Phys Med Rehabil 2002; 83: 1342–1348.

13.

Candia

Wienbruch

Elbert

et al. Effective behavioural treatment of focal hand dystonia in musicians alters somatosensory cortical organisation. Proc Natl Acad Sci U S A 2003. June 24; 100(13): 7942–6.

14.

Ramachandran

and Hirstein

The perception of phantom limbs. Brain 1998; 121: 160–163.

15.

Sakai

Slow-down exercise for the treatment of focal hand dystonia in pianists. Med Probl Perform Art 2006; 21: 25–28.

16.

Simons

Travell

Simons

LS.

Myofascial pain and dysfunction: The trigger point manual. Volume 1: Upper half of body. 2nd ed. Baltimore: Lippincott, Williams and Wilkins,1999, p.11–93

17.

Aguilera

Montanez

Pecos

et al . Immediate effect of ultrasound treatment and ischaemic compression techniques for the treatment of trapezius latent myofascial trigger points in healthy subjects: a randomised controlled study. Manipulative Physiol Ther 2009; 32: 515–520.

18.

Saime

Sebnem

Deniz

et al . Comparison the efficacy of phonophoresis and ultrasound therapy in myofascial pain syndrome. Rheumatol Int 2011; 31: 1203–1208.

19.

Tubiana

Musician's focal dystonia. In: Tubiana

and Amadio

(eds) Medical problems of the instrumental musician. London: Martin Dunitz, 2000, pp.329–342.

20.

Erwin

Keller

Anderson

et al . Hand and wrist strengthening exercises during rehabilitation of a patient with hereditary distal myopathy. Arch Phys Med Rehabil 1991; 72: 701–702.

21.

Fahn

Assessment of the primary dystonias. In: Munsat

(ed.) Quantification of neurologic deficit. Newton, MA: Butterworth-Heineman, 1989, pp.187–195.

22.

Walter

Buttkus

Benecke

et al . Sonographic alteration of lenticular nucleus in focal task-specific dystonia of musicians. Neurodegenerative Dis 2012; 9: 99–103.

23.

Schuele

Jabusch

H-C

Lederman

et al . Botulinum toxin injections in the treatment of musician's dystonia. Neurology 2005; 64: 341–343.

24.

Schabrun

Stinear

Byblow

et al . Normalizing motor cortex representations in focal hand dystonia. Cereb Cortex 2009; 19: 1968–1977.

25.

Tubiana

Musician's focal dystonia. In: Tubiana

and Amadio

(eds) Medical problems of the instrumentalist musician. London: Martin Dunitz, 2000, pp.329–342.

26.

Tubiana

Musician's focal dystonia. Hand Clin 2003; 19: 308.

27.

Priori

Pesenti

Cappellari

et al . Limb immobilization for the treatment of focal occupational dystonia. Neurology 2001; 57: 405–409.

28.

Ackermann

and Adams

Finger movement discrimination in focal hand dystonia: case study of a cellist. Med Probl Perform Art 2005; 20: 77–81.

29.

Berque

Gray

Harkness

et al . A combination of constraint-induced therapy and motor control retraining in the treatment of focal hand dystonia in musicians. Med Probl Perfor Art 2010; 25: 149–161.

30.

Broadbent

Petrie

Main

et al . The Brief Illness Perception Questionnaire (BIPQ). J Psychosom Res 2006; 60: 631–637.

31.

Herdman

Gudex

and Lloyd

Development and preliminary testing of the new five-level version of the EQ-5D (EQ-5D-5L). Qual Life Res 2011; 20: 1727–1736.

32.

Guy

WECDEU.

Assessment manual for psychopharmacology – clinical global impression (CGI). Rockville: U.S. Department of Health, Education, and Welfare, 1976.

33.

Carson

AJ.

The outcome of neurology outpatients with medically unexplained symptoms: a prospective cohort study. J Nerol Neurosurg Psychiartry 2003; 74: 897–890.

34.

Sharpe

Walker

Williams

et al . Guided self-help for functional (psychogenic) symptoms: a randomized controlled efficacy trial. Neurology 2011; 77: 562–572.

35.

Eldridge

Chan

Campbell

et al . CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ 2016; 355: i5239.

36.

Stangroom, J. Social Science Statistics. http://www.socscistatistics.com/effectsize (2018, accessed 9 March 2018).

37.

Sedgwick

Effect sizes. BMJ 2012; 7370: 345.

38.

Zosso

and Schoeb

Musicians’ social representations of health and illness: a qualitative case study about focal dystonia. Work 2012; 41: 53–59.

39.

Altenmuller

and Jabusch

H-C.

Focal dystonia in musicians: phenomenology, etiology, and psychological trigger factors. J Hand Ther 2009; 22: 144–155.

40.

Eldridge

et al . Defining feasibility and pilot studies in preparation for randomised controlled trials: development of a conceptual framework. PLoS One 2016; 11: e0150205.