A Case Report: Using Multimodalities to Examine a Professional Pianist with Focal Dystonia

Task-specific dystonia is characterized by excessive muscle contractions producing abnormal postures. These structural and functional changes are known to be a result of maladaptive neuroplasticity to prolonged, intense, repetitive movement. While some factors of neuropathology of focal dystonia are known, the etiology of task-induced focal dystonia and effective treatments are unknown. We examined hand biomechanics, neurophysiology, and music performance outcomes in a 53-year-old male pianist with dystonic extension of the left third digit while playing the piano. We aimed to gain information that can help develop a holistic rehabilitation strategy. The pianist led a life with constricted work patterns leaving little time to recharge or relax. He had large hands with a hypermobile structure. Music Instrument Digital Interface (MIDI) data showed the lack of fine digital touch control required for skilled music playing. Functional magnetic resonance imaging (fMRI) demonstrated enhanced activity in contralateral primary sensorimotor cortex, supplementary motor area, and parietal-occipital regions during simulated left-hand scale playing. Intramuscular needle EMG analysis demonstrated hyperactivation of the left extensor digitorum communis (EDC) with a distinct periodic oscillatory pattern during and persisting after playing, which was not as prominent in the unaffected extensor indicis proprius (EIP), thus demonstrating that pianist’s focal dystonia was associated with increased activity in the contralateral motor cortex area and a distinct oscillatory EMG activity. Video recording of retraining sessions using a vibrotactile sensor showed progress. A complete recovery of the affected finger deficit remains elusive after the 8-week retraining.