Of the many interesting topics covered at the congress, the talk by Laurent Boullet stood out. He is a Belgian concert painist who experienced focal hand dystonia himself. Now Laurent works with muscians who also suffer focal hand dystonia, using a programme to retain normal control of movement. He follows the principles of rehabilitation, gradually building the challenge of movement and precision required for playing the piano.
A graph that Laurent displayed showed how there is extra and early activity in the muscular system, a feature that is most significant with dystonia – too much activity and at the wrong time. The training seeks to change this patterning and restore the more discrete control.
Laurent has noticed that children often display similar movement patterns to those who have focal hand dystonia. I found this point to be highly relevant as I use the analogy that when there is an issue with movement, we lose precision and perform actions much like a young child, grasping rather than the refined movements of an adult with skill (although we do not often think about our movements as ‘skill’, this is indeed what they must be for success). Of course, precision must be learned by children and re-learned by adults with dystonia.
Recognising that there are changes in the brain functioning that underpin dystonia, there was a focus upon targeting these adaptations. Of course, any learning is a brain-based activity, whether it be a language or a musical instrument.
Two further observations by Laurent were the fact that muscle fibre switching may take place (fast & slow twitch fibres) and that the overall patterning of movement changes including the postural muscles. In respect of the latter, he referred to the work of Hodges et al. (click here), ‘Experimental muscle pain changes feedforward postural responses of the trunk muscles’ that shows how the feedforward system changes postural activity, relating that to dystonia.
In summary, although the problem manifests about the hand we are really thinking about a whole body strategy to move the arm to a certain place where the hand can perform intricate and timed activity. The automatic nature of movement changes and becomes increasingly conscious and therefore where our attention lies is important. The classic example is the yips (a later blog on this fascinating area). In focal hand dystonia we must consider this overall patterning but also the cognitive and emotional dimensions, similar to pain, addressing how these aspects of being human affect movement.