RESEARCH QUESTION: What is the effectiveness of neuromuscular reeducation programs on reducing abnormal movements during instrument play in musicians with focal hand dystonia (FHD)?

RATIONALE: For musicians, music holds a dynamic position among the occupations of self-care, productivity, and leisure (American Occupational Therapy Association, 2014; Guptill, 2014). FHD is a task-specific movement disorder characterized by involuntary muscle contractions and postures affecting extensively trained movements. Musicians are particularly susceptible to developing this type of dystonia due to the frequently repeated movements used in playing instruments.

Currently, there is no cure for FHD. Neuromuscular reeducation programs aim to improve motor control, sensory discrimination, and performance through normalizing cortical representations of affected digits that become blurred in FHD.

DESIGN: A systematic review of the literature was performed.

PARTICIPANTS: All studies met the following inclusion criteria: published from 2000 to 2015 in a peer-reviewed journal; presented outcome-based research; and the studied intervention could be carried out by an occupational therapist. Studies in which fewer than half of the participants were musicians were excluded.

METHOD: Electronic databases searched included MEDLINE, CINAHL, PsycINFO, and Cochrane Library. MeSH headings included dystonic disorders, neurofeedback/behavior therapy/exercise therapy, and recovery of function/treatment outcome. Additional studies were identified from article reference lists.

ANALYSIS: Studies meeting the criteria above were assessed by two authors for eligibility and quality of methods. Data were extracted into a critical appraisal chart.

RESULTS: Six studies met the inclusion criteria, 2 nonrandomized two-group studies and 4 one-group nonrandomized studies. The studied neuromuscular reeducation programs included constraint-induced therapy plus motor control retraining, sensory–motor returning, and learning-based sensorimotor retraining. Altered auditory and sensory feedback strategies were also evaluated. Neuromuscular reeducation programs were effective in reducing dystonic movements during instrument play as evidenced by significant improvements on scales that measure the frequency and severity of dystonic or abnormal movements. Altered sensory feedback strategies, such as wearing a latex glove, significantly improved fine motor control in some participants. Altered auditory feedback was not effective in reducing dystonic movements.

DISCUSSION: The results of this review indicate there is moderate evidence to support the effectiveness of neuromuscular reeducation programs on reducing abnormal movements during instrument play in musicians with FHD. However, additional research should evaluate the effectiveness of neuromuscular reeducation programs using a randomized controlled trial design.

The current research has indicated that reeducation programs must be intensive in frequency and duration. Effective reeducation programs required 2–3 hr of training each day for ≤12 mo. Neuromuscular reeducation programs were more effective when task specific, requiring the client to complete exercises on their instrument.

IMPACT STATEMENT: Currently, there is no cure for FHD. Neuromuscular reeducation programs may improve outcomes for affected musicians and expand occupational therapy’s role in the lives of musicians.

American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process. American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006

Guptill, C. (2014). Musician’s health: A developing role for occupational therapists. Occupational Therapy Now, 16(6), 29–31.