A combination of constraint-induced therapy and motor control retraining in the treatment of focal hand dystonia in musicians

2010 ◽  
Vol 25 (4) ◽  
pp. 149-161 ◽  
Author(s):  
Patrice Berque ◽  
Heather Gray ◽  
Cassandra Harkness ◽  
Angus McFadyen
Keyword(s):  
Motor Control ◽  
Repeated Measures ◽  
Behavioural Therapy ◽  
Motor Disorder ◽  
Focal Hand Dystonia ◽  
Video Recordings ◽  
Abnormal Movements ◽  
Scale Scores ◽  
Post Hoc ◽  
Hand Dystonia

Focal hand dystonia (FHD) in musicians is a painless task-specific motor disorder characterized by an involuntary loss of control of individual finger movements. The aim of this study was to investigate the effects of an innovative behavioural therapy intervention, aimed at normalising movement patterns, in musicians affected by FHD. METHODS: Eight musicians volunteered to take part in this retraining protocol. Intensive constraint-induced therapy and motor control retraining at slow speed were the interventions. Video recordings of the subjects playing two pieces were used for data analysis. The Frequency of Abnormal Movements scale (FAM), the change in metronome speed achieved during motor control retraining, and two ordinal dystonia evaluation scales were chosen as outcome measures. It was hypothesised that there would be significant differences in the FAM scores and metronome speeds over a 12-month period. RESULTS: For the main outcome measure, the FAM scale scores, the two-factor repeated measures ANOVA revealed a very significant decrease in the number of abnormal movements per second of instrumental playing over the 12-month period (F = 6.32, df = 7, p<0.001). Tukey's post-hoc tests carried out for the FAM scores revealed that significant changes occurred after 8 months of therapy. DISCUSSION: These results suggest that a combination of constraint-induced therapy and specific motor control retraining may be a successful strategy for the treatment of musicians' FHD. Furthermore, the results suggest that retraining strategies may need to be carried out for at least 8 months before statistically significant changes are noted.

A Combination of Constraint-Induced Therapy and Motor Control Retraining in the Treatment of Focal Hand Dystonia in Musicians: A Long-term Follow-up Study

2013 ◽  
Vol 28 (1) ◽  
pp. 33-46 ◽  
Author(s):  
Patrice Berque ◽  
Heather Gray ◽  
Angus McFadyen
Keyword(s):  
Motor Control ◽  
Repeated Measures ◽  
Motor Disorder ◽  
Long Term Effects ◽  
Focal Hand Dystonia ◽  
Repeated Measures Design ◽  
Abnormal Movements ◽  
Hand Dystonia

Focal hand dystonia (FHD) in musicians is a painless, task-specific motor disorder characterized by involuntary loss of control of individual finger movements. The aim of this study was to investigate the long-term effects of a combined behavioral therapy intervention aimed at normalizing finger movement patterns. METHODS: Eight musicians with FHD had taken part in the 1-year study involving intensive constraint-induced therapy and motor control retraining at slow speed as the interventions. Four of these subjects volunteered to take part in this 4-year follow-up. A quasi-experimental, repeated measures design was used, with 9 testing sessions over 4 years. Video recordings of the subjects playing two pieces were used for data analysis. The Frequency of Abnormal Movements scale (FAM) was the main outcome measure. It was hypothesized that there would be significant differences in FAM scores achieved over the 4-year period. RESULTS: The results from the ANOVA revealed a significant decrease, by approximately 80%, in the number of abnormal movements for both pieces over the 4-year period (F=7.85, df=8, p<0.001). Tukey’s post-hoc test revealed that significant improvements occurred after 6 months of therapy (p-values between p<0.001 and p=0.044). Although the results were not significant between month 12 and follow-up at year 4, the trend revealed that the progress achieved during the first year of intensive retraining was maintained at year 4. CONCLUSIONS: A 1-year period of intensive task-specific retraining may be a successful strategy with long-term, lasting effects for the treatment of musician’s FHD. Results suggest that retraining strategies may need to be carried out for at least 6 months before statistically significant changes are noted.

Neuromuscular Re-Education Programs for Musicians with Focal Hand Dystonia: A Systematic Review

2018 ◽  
Vol 33 (2) ◽  
pp. 137-145 ◽  
Author(s):  
Ashley M Enke ◽  
Gail A Poskey
Keyword(s):  
Systematic Review ◽  
Repeated Measures ◽  
Cochrane Library ◽  
Single Subject ◽  
Inclusion Criteria ◽  
Sensorimotor Training ◽  
Education Programs ◽  
Focal Hand Dystonia ◽  
Abnormal Movements ◽  
Hand Dystonia

OBJECTIVE: The purpose of this systematic review was to evaluate the effectiveness of neuromuscular re-education programs on reducing abnormal movements during instrument play in musicians with focal hand dystonia (FHD). METHODS: A systematic literature search of published articles was performed. Databases searched included MEDLINE, CINAHL, PsycINFO, OTseeker, and the Cochrane Library. Additional articles were identified from reference lists. Studies meeting inclusion criteria were independently assessed by the two coauthors for eligibility and quality of methods. Study data were summarized in a critical appraisal chart. RESULTS: Nine studies met the inclusion criteria for review, including 1 non-randomized two-group study, 6 single-group repeated measures studies, and 2 single-subject studies. The studied neuromuscular re-education programs included constraint-induced therapy plus motor control retraining, sensory motor retuning, learning- based sensorimotor training, and slow-down exercise. CONCLUSIONS: The results of this review indicate there is moderate evidence to support the effectiveness of neuromuscular re-education programs on reducing abnormal movements during instrument play in musicians with FHD. However, additional research should evaluate the effectiveness of neuromuscular re-education programs using reliable and valid outcome measures, as well as study methods which provide higher levels of evidence.

Assessment of the effects of Kinesiotaping on musical motor performance in musicians suffering from focal hand dystonia: a pilot study

2019 ◽  
Vol 33 (10) ◽  
pp. 1636-1648 ◽  
Author(s):  
Riccardo Bravi ◽  
Christos I Ioannou ◽  
Diego Minciacchi ◽  
Eckart Altenmüller
Keyword(s):  
Pilot Study ◽  
Repeated Measures ◽  
Motor Performance ◽  
Fine Motor ◽  
Electromyographic Activity ◽  
Focal Hand Dystonia ◽  
General Performance ◽  
Antagonist Muscles ◽  
Hand Dystonia ◽  
Analogue Scales

Objective:The aim of this study was to explore the immediate and short-term effects of a Correction Kinesiotaping intervention on fine motor control in musicians with focal hand dystonia.Design:A single-blinded, single-arm repeated measures, pilot study.Setting:Medical outpatient clinic.Subjects:Seven musicians diagnosed with focal hand dystonia.Interventions:Musicians performed musical exercises under the following conditions: without Kinesiotape (baseline), during a Correction Kinesiotaping intervention and immediately after tape removal (block 1) and during a Sham Kinesiotaping intervention and immediately after tape removal (block 2). Blocks were randomly presented across participants. A tailored Correction Kinesiotaping intervention on affected fingers was provided based on the dystonic pattern that each patient manifested while playing.Main measures:Motor performance was video-documented and independent experts blindly assessed the general performance and fingers’ posture on visual analogue scales. Also, musicians’ self-reports of the musical abilities were evaluated. Finally, electromyographic activity and coactivation index of wrist antagonist muscles were analyzed.Results:No significant differences in effects between Correction Kinesiotaping and Sham Kinesiotaping were reported by the experts, either for general performance ( P > 0.05) or for fingers’ posture ( P > 0.05); any subtle benefits observed during Correction Kinesiotaping were lost after the tape was removed. Musicians estimated that Correction Kinesiotaping was ineffective in improving their musical abilities. Also, no significant changes with respect to the coactivation index ( P > 0.05) were found among the conditions.Conclusion:Correction Kinesiotaping intervention may not be useful to reduce dystonic patterns, nor to improve playing ability, in musicians with focal hand dystonia.

scholarly journals Testing rTMS-Induced Neuroplasticity: A Single Case Study of Focal Hand Dystonia

2018 ◽  
Vol 2018 ◽  
pp. 1-12 ◽  
Author(s):  
Sonia Betti ◽  
Andrea Spoto ◽  
Umberto Castiello ◽  
Luisa Sartori
Keyword(s):  
Kinematic Analysis ◽  
Motor Coordination ◽  
Repetitive Transcranial Magnetic Stimulation ◽  
Single Case ◽  
Motor Disorder ◽  
Single Case Study ◽  
Reach To Grasp ◽  
Focal Hand Dystonia ◽  
Hand Dystonia

Focal hand dystonia in musicians is a neurological motor disorder in which aberrant plasticity is caused by excessive repetitive use. This work’s purposes were to induce plasticity changes in a dystonic musician through five daily thirty-minute sessions of 1 Hz repetitive transcranial magnetic stimulation (rTMS) applied to the left M1 by using neuronavigated stimulation and to reliably measure the effect of these changes. To this aim, the relationship between neuroplasticity changes and motor recovery was investigated using fine-grained kinematic analysis. Our results suggest a statistically significant improvement in motor coordination both in a task resembling the dystonic-inducing symptoms and in a reach-to-grasp task. This single case study supports the safe and effective use of noninvasive brain stimulation in neurologic patients and highlights the importance of evaluating outcomes in measurable ways. This issue is a key aspect to focus on to classify the clinical expression of dystonia. These preliminary results promote the adoption of kinematic analysis as a valuable diagnostic tool.

Music Stimuli for Mindfulness Practice: A Replication Study

2020 ◽  
Author(s):  
Eugenia Hernandez-Ruiz ◽  
Abbey L Dvorak
Keyword(s):  
Repeated Measures ◽  
Mindfulness Practice ◽  
Auditory Stimuli ◽  
Present Moment ◽  
Complex Stimulus ◽  
Friedman Analysis ◽  
Scale Scores ◽  
Mindfulness Practices ◽  
Within Subjects ◽  
Post Hoc

Abstract Mindfulness is a natural human capacity to be aware of the present moment, without judgment, rejection, or attachment to it. Cultivating a mindful state has been related to improvements in mood and stress management. Mindfulness practices may be enhanced with music. The purpose of this study was to replicate a previous study regarding the effectiveness, preference, and usefulness of different auditory stimuli for mindfulness practice. Undergraduate nonmusicians (N = 53) listened to 4 different auditory stimuli of increasing complexity, guiding them in a mindfulness experience. Participants rated their mindfulness experience, provided data on their absorption in music, and ranked auditory stimuli according to preference and usefulness for mindfulness practice. A within-subjects design was used to compare the four conditions, counterbalanced, and randomized across participants. Similar to the original study, Friedman analysis of variances (ANOVAs) and post hoc analyses indicated that participants ranked the Melody and Harmony conditions as most preferred and useful. Different from the original results, the repeated-measures ANOVA of the Mindful Attention Awareness Scale scores did not reveal significant differences among auditory stimuli for mindfulness experience. These results provide support for the use of music in mindfulness experiences with a mildly complex stimulus (script, beat, harmony, and melody). However, partially replicated results indicate the need to investigate the discrepancy between participants’ effectiveness ratings and preference/usefulness rankings.

Focal Hand Dystonia: A Functional Imaging Study

2005 ◽  
Vol 32 (06) ◽  
Author(s):  
M Peller ◽  
K Zeuner ◽  
M Weiss ◽  
A Knutzen ◽  
G Deuschl ◽  
...  
Keyword(s):  
Functional Imaging ◽  
Imaging Study ◽  
Focal Hand Dystonia ◽  
Functional Imaging Study ◽  
Hand Dystonia

scholarly journals Efficacy of galcanezumab in patients with migraine who did not benefit from commonly prescribed preventive treatments

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dulanji K. Kuruppu ◽  
Joshua Tobin ◽  
Yan Dong ◽  
Sheena K. Aurora ◽  
Laura Yunes-Medina ◽  
...  
Keyword(s):  
Repeated Measures ◽  
Migraine Headache ◽  
Mixed Model ◽  
Preventive Treatment ◽  
Response Rates ◽  
Toxin A ◽  
Double Blind ◽  
Preventive Medication ◽  
Onabotulinum Toxin A ◽  
Post Hoc

Abstract Background Galcanezumab is a calcitonin gene-related peptide (CGRP) monoclonal antibody (mAb) indicated for the preventive treatment of migraine. While galcanezumab has demonstrated efficacy in patients who did not respond to prior preventive medications in general, its efficacy in patients who did not benefit from individual, commonly prescribed preventive treatments due to inadequate efficacy or safety/tolerability remains unknown. Methods CONQUER was a 3-month, randomized, double-blind, placebo-controlled, phase 3b study that enrolled patients with episodic or chronic migraine who had 2 to 4 migraine preventive medication category failures in the past 10 years. Patients were randomly assigned 1:1 to receive placebo (N = 230) or galcanezumab 120 mg/month (240 mg loading dose; N = 232). Post hoc analyses were conducted to determine the efficacy of galcanezumab in patients who had not benefited from six of the most commonly prescribed migraine preventive medications. The mean change from baseline in monthly migraine headache days and ≥ 50 % response rates were assessed over months 1–3. Improvement in Migraine-Specific Questionnaire Role Function-Restrictive (MSQ-RFR) scores were assessed at month 3. The endpoints were estimated via mixed model with repeated measures. Results The most common treatment failures due to inadequate efficacy or safety/tolerability, which at least 20 % of patients reported trying without benefit, included topiramate, amitriptyline, propranolol, valproate or divalproex, onabotulinum toxin A, and metoprolol. Patients who had not previously benefited from these treatments had a greater mean reduction in monthly migraine headache days across months 1–3 in the galcanezumab group compared to placebo (all p < 0.01). More patients treated with galcanezumab experienced a ≥ 50 % reduction from baseline in monthly migraine headache days across months 1–3 compared to placebo (all p < 0.05). Galcanezumab-treated patients had a greater improvement in mean MSQ-RFR scores at month 3 compared to placebo (all p < 0.01). Conclusions In this population, galcanezumab was effective in reducing monthly migraine headache days, improving response rates, and enhancing quality of life in patients who had not previously benefited from topiramate, amitriptyline, propranolol, valproate or divalproex, onabotulinum toxin A, and/or metoprolol due to inadequate efficacy or safety/tolerability. Trial registration ClinicalTrials.gov NCT03559257 (CONQUER).

Pilot evaluation of a group stabilisation intervention for refugees and asylum seekers with PTSD

2021 ◽  
pp. 1-6
Author(s):  
Mary Griggs ◽  
Cheng Liu ◽  
Kate Cooper
Keyword(s):  
Repeated Measures ◽  
Asylum Seekers ◽  
Preliminary Evidence ◽  
Behavioural Therapy ◽  
Post Traumatic Stress ◽  
Group Setting ◽  
Post Intervention ◽  
Treatment Delivery ◽  
Cognitive Behavioural ◽  
The Uk

Abstract Background: Post-traumatic stress disorder (PTSD) is commonly experienced by asylum seekers and refugees (ASR). Evidence supports the use of cognitive behavioural therapy-based treatments, but not in group format for this population. However, group-based treatments are frequently used as a first-line intervention in the UK. Aims: This study investigated the feasibility of delivering a group-based, manualised stabilisation course specifically developed for ASR. The second aim was to evaluate the use of routine outcome measures (ROMs) to capture psychological change in this population. Method: Eighty-two participants from 22 countries attended the 8-session Moving On After Trauma (MOAT) group-based stabilisation treatment. PHQ-9, GAD-7, IES-R and idiosyncratic outcomes were administered pre- and post-intervention. Results: Seventy-one per cent of participants (n = 58) attended five or more of the treatment sessions. While completion rates of the ROMs were poor – measures were completed at pre- and post-intervention for 46% participants (n = 38) – a repeated-measures MANOVA indicated significant improvements in depression (p = .001, ηp2 = .262), anxiety (p = .000, ηp2 = .390), PTSD (p = .001, ηp2 = .393) and idiosyncratic measures (p = .000, ηp2 = .593) following the intervention. Conclusions: Preliminary evidence indicates that ASR who attended a low-intensity, group-based stabilisation group for PTSD experienced lower mental health scores post-group, although the lack of a comparison group means these results should be interpreted with caution. There are significant challenges in administering ROMs to individuals who speak many different languages, in a group setting. Nonetheless, groups have benefits including efficiency of treatment delivery which should also be considered.

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