Journal of Hand Therapy
Volume 22, Issue 2 , Pages 172-182, April 2009

Differences in Physical Characteristics and Response to Rehabilitation for Patients with Hand Dystonia: Musicians' Cramp Compared to Writers' Cramp

  • Alison L. McKenzie, PT, PhD

      Affiliations

    • Corresponding Author InformationCorrespondence and reprint requests to Alison L. McKenzie, PT, PhD, Department of Physical Therapy, Chapman University, One University Drive, Orange, CA 92624
  • Cindy Barrango, DPT

      Affiliations

    • Work completed in partial fulfillment of the Doctor of Physical Therapy Degree at Chapman University, Orange, California.
  • Tricia Wong, DPT

      Affiliations

    • Work completed in partial fulfillment of the Doctor of Physical Therapy Degree at Chapman University, Orange, California.
  • Nancy Byl, PT, PhD

      Affiliations

    • Work completed in partial fulfillment of the Doctor of Physical Therapy Degree at Chapman University, Orange, California.

Department of Physical Therapy, Chapman University, One University Drive, Orange, California

U.S. Army Research Institute of Environmental Medicine, Military Performance Division, Kansas Street, Building #42, Natick, Massachusetts

Department of Physical Therapy, Chapman University, One University Drive, Orange, California

Department of Physical Therapy, Chapman University, One University Drive, Orange, California

Department of Physical Therapy, Chapman University, One University Drive, Orange, California

Department of Physical Therapy and Rehabilitation Science, Box 0736, University of California at San Francisco, San Francisco, California

Abstract 

Study Design

Pre-Post, Mixed Factorial Trial.

Introduction

Focal hand dystonia is a challenging movement disorder to rehabilitate in musicians and writers.

Purpose of the Study

To compare the neuromusculoskeletal characteristics of those with writers' cramp (WC) and musicians' cramp (MC), and evaluate responsiveness to learning-based sensorimotor training.

Methods

Twenty-seven individuals (14 musicians, 13 writers) participated in 8 weeks of supervised therapy supplemented with a home program. Between-group differences on measures of musculoskeletal (physical), sensory, and motor performance were evaluated at baseline and post-intervention.

Results

Subjects with MC had a higher level of functional independence and better range of motion, but less strength in the affected upper limb than those of subjects with WC. Subjects with MC demonstrated greater accuracy on graphesthesia, kinesthesia, and localization at baseline. No between-group differences in motor performance were noted at baseline or post-intervention. Following individually adapted learning-based sensorimotor training, both groups improved in musculoskeletal (physical) parameters, sensory processing, and motor control; however, improvements on certain subtests differed by group. At follow-up, differences in posture, ROM, strength, graphesthesia, and kinesthesia persisted between the groups.

Conclusions

Subjects with WC have different physical and performance risk factors compared with those of subjects with MC. Intervention paradigms are efficacious, but variable responses to rehabilitation occur.

Level of Evidence

4.

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PII: S0894-1130(09)00002-7

doi:10.1016/j.jht.2008.12.006

Journal of Hand Therapy
Volume 22, Issue 2 , Pages 172-182, April 2009

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