Differences in Physical Characteristics and Response to Rehabilitation for Patients with Hand Dystonia: Musicians' Cramp Compared to Writers' Cramp
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.
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
Correspondence and reprint requests to Alison L. McKenzie, PT, PhD, Department of Physical Therapy, Chapman University, One University Drive, Orange, CA 92624
∗ Work completed in partial fulfillment of the Doctor of Physical Therapy Degree at Chapman University, Orange, California.
ABSTRACT