Focal Dystonia


Focal dystonia is a neurological disorder that causes involuntary muscle contractions. It has affected a number of famous musicians, including pianist Leon Fleisher. Although focal dystonia is experienced in the muscles, the problem is rooted in the brain.

Brain mapping shows that individuals affected with focal dystonia present abnormal somatosensory reorganization. With a pianist, for example, normally separate representational areas for the fingers may become overlapped or fused. Apparently, command areas in the brain overlap not because of physical proximity in the body, but from task-oriented proximity. Theresa Lie-Nemeth, in “Focal Dystonia in Musicians,” cites a study in which wind/brass players who have embouchure dystonia show a blurring between brain regions dedicated to the fingers and lips.

Eckart  Altenmüller, in a chapter titled, “The Musician’s Brain as a Model for Adaptive and Maladaptive Plasticity,” writes that focal dystonia may have begun for musicians in the 19th century, along with the increased technical demands (and requisite long hours of practice) of performing virtuosic music. (Altenmüller posits that Robert Schumann may have suffered from focal dystonia).  It is well established that extreme usage levels can contribute to focal dystonia, but for three reasons I find the timeline unconvincing.  First, an initial documentation does not mean a first occurrence.  Second, there was plenty of virtuosic music and existence before the 19th century. (There was an article last month in The New Yorker discussing golfers with the yips, golf lingo for focal dystonia.  If putting a golf ball is “virtuosic” in the same way as performing a caprice by Paganini, perhaps we need to define the term more carefully.) Third, in addition to extreme usage, researchers have found other factors that trigger focal dystonia, including: tension, performance anxiety, and nervousness in general, as well as genetic disorders, disease, and stroke.

As a result of my stroke, I have dystonia.  I arrived at my dystonia from the opposite direction as did Mr. Fleisher, of course.  For Fleischer, once separate, and extraordinarily developed, brain areas apparently became fused.  My problem stems not from overdevelopment, but from underdevelopment.  My struggle is not with specialized areas merging, but from lack of “brain fences.” Directions sent to my stroke-affected left side are received with flashlight-beam width, rather than laser precision. For example, if I imagine moving my left-hand ring finger, all of the fingers, even my entire arm, will begin to tingle. (Imagine a flock of birds. One takes to flight and the rest follow.) These effects resonate across my entire left side.  If I think about to raising my big toe, my index finger will tingle in sympathy, perhaps even move.  If I curl my little toe, my pinky wants to curl right along with it.  Although they are less insistent, similar reflections also move in the opposite direction, from hand to foot.

To a great extent our life in the world is a result of what and how we think. It is possible that through inattention I have augmented my dystonia problem.  By “accepting” these connections, I may have strengthened the wiring between them. (I expected these tendencies to disappear automatically as I regained facility.  Perhaps they still will. In the first months after my stroke, when I began practicing drum rudiments, the left hand’s [or stick’s] impact would cause my entire left side to tremor. No longer.)

Unfortunately, I cannot report that I have an efficient strategy to mitigate the problem. (Suggestions are welcome!) The simple act of thinking about my left-hand thumb still triggers my entire arm to tingle. As with Mr. Fleisher, fingers curl unbeckoned.

That confession made, I will share some large-scale body movements I practice to weaken limb reflection. For me, virtually every movement exercise involving limb independence has proven beneficial, if not completely restorative.

  • Tai-chi movements (and all martial art movements when done slowly and with mental presence).
  • Mirrored, opposite, and contrasting movements, either bilateral or affected side only (between the weakened arm and leg, hand and foot, fingers and toes). Practice simple exercises slowly.
  • Walking sideways or backwards, dancing, swimming, and virtually any exercise.

And of course there are drumming exercises.  To strengthen limb independence, I like to play patterns not only between both hands but also between hand and foot. (When working with hand and foot, I mostly focus on my weakened side, but I also perform the patterns between all four limbs.) I will suggest exercises in a future post.

2 thoughts on “Focal Dystonia

  1. Wondering if I can make contact with the individual who wrote this article, it would be rather imperative for me to do so.

    Sincerest regards,

    Adam-Philip Livingston.

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