Special Issue| Volume 22, ISSUE 2, P183-198, April 2009

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Focal Hand Dystonia: Effectiveness of a Home Program of Fitness and Learning-based Sensorimotor and Memory Training

Published:March 16, 2009DOI:


      Study Design

      This was a pre post test design.


      Retraining the brain is one approach to remediate movement dysfunction resulting from task specific focal hand dystonia (FHDTSP).


      Document change in task specific performance (TSP) for patients with FHDTSP after 8 weeks of comprehensive home training (fitness activities, task practice, learning based memory and sensorimotor training).


      Thirteen subjects were admitted and evaluated at baseline, immediately and 6 months post treatment for task specific performance, functional independence, sensory discrimination, fine motor speed and strength. In Phase I, 10 subjects were randomly assigned to home training alone or supervised practice prior to initiating the home training. In phase II, 2 subjects crossed over and 3 new subjects were added (18 hands). The intent to treat model was followed. Outcomes were summarized by median, effect size, and proportion improving with nonparametric analysis for significance.


      Immediately post-intervention, TSP, sensory discrimination, and fine motor speed improved 60-80% (p<0.00l respectively). Functional independence and strength improved by 50%. Eleven subjects (16 hands) were re-evaluated at 6 months; all but one subject reported a return to work. Task-specific performance was scored 84-90%. Supervised practice was associated with greater compliance and greater gains in performance.


      Progressive task practice plus learning based memory and sensorimotor training can improve TSP in patients with FHDTSP. Compliance with home training is enhanced when initiated with supervised practice.

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      JHT Read for Credit

      Quiz: Article # 128

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.
      • #1.
        The primary difference between groups was that the
        • a.
          “Home + Group” was given a more complete set of initial instructions
        • b.
          “Home Group” was given a more complete set of initial instructions
        • c.
          “Home + Group” received on-going supervised instructions in therapy sessions whereas the “Home Group” received no additional supervision after the initial instruction session
        • d.
          “Home + Group” had frequent unsupervised individual practice sessions during therapy visits whereas the “Home Group” did all their practicing at home
      • #2.
        BrainFit refers to the
        • a.
          software that was installed on the subjects' home computers
        • b.
          software the investigators used in the initial screening process to select subjects
        • c.
          instrument used by the investigators to measure the head size of each subject in order to insure that the cranial harness fit properly
        • d.
          outcome measuring instrument
      • #3.
        During evaluation sessions the
        • a.
          trained investigators evaluated the subjects' performance in real time as the task was being performed
        • b.
          trained investigators conducted interviews with the subjects immediately following the task
        • c.
          final product (e.g. a writing sample) was recorded by a still digital camera for subsequent analysis
        • d.
          subjects' performance was videotaped for subsequent analysis
      • #4.
        The home program included ____ forms of intervention
        • a.
        • b.
        • c.
        • d.
      • #5.
        According to the authors, the primary objective of therapy for FHd TSP should be
        • a.
          sensory retraining
        • b.
          retraining the brain
        • c.
          fine motor retraining
        • d.
          coordination retraining
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.