Effects of Pianism Retraining on Three Pianists with Focal Dystonia

Focal dystonia is a debilitating movement disorder that occurs from many repetitions of a specific task. It typically manifests in involuntary muscle contractions and, in pianists, causes an incoordination between fingers, making it impossible to play at concert level. Prognosis is poor, and most sufferers are forced to abandon their careers. The aim of this research was to ascertain whether pianism retraining would enable pianists affected by focal hand dystonia to play again. Three pianists with focal hand dystonia participated in a retraining programme based on a biomechanically sound way of playing with minimal tension. Quality of scales and repertoire were assessed before and after pianism retraining by several rating systems, which included assessment by a listener blinded as to which hand was dystonic and whether the playing was pre- or post-retraining. Scale quality improved with retraining (p < 0.0001) in all three pianists, with improvement in both hands but greater improvement in the dystonic hand. Although there was no change in the blinded listener's ability to identify the nondystonic hand from pre-retraining to post-retraining, they could correctly identify the dystonic hand 79% of the time pre-retraining, but this decreased to 28% post-retraining. The test repertoire evaluation and the visual evaluation rating were shown to improve significantly by 1.0 and 1.3 points, respectively (on a five-point rating system), from pre-retraining to post-retraining (p < 0.0001). Our data show that pianism retraining can improve the symptoms of focal dystonia in pianists.