Abstract
Study Design
This was a pre post test design.
Introduction
Retraining the brain is one approach to remediate movement dysfunction resulting from
task specific focal hand dystonia (FHDTSP).
Purpose
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).
Methods
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.
Results
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.
Conclusions
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.
Level of Evidence
4.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hand cramps: clinical features and electromyographic patterns in a focal dystonia.Neurology. 1988; 38: 1005-1012
- Epidemiology, phenomenology and therapy of musician's cramp.in: Altenmuller E. Wiesendanger M. Kesselring J. Music, Motor Control and the Brain. Oxford University Press, New York, NY2006: 265-287
- Focal hand dystonia.Pract Neurol. 2006; 6: 2542-2557
- Focal dystonia: advances in brain imaging and understanding of fine motor control in musicians.Hand Clin. 2003; 19: 1-16
- The End of the Song? Robert Schumann's Focal Dystonia.in: Altenmüller E. Wiesendanger K.M. Kesselring J. Music, Motor Control and the Brain. Oxford University Press, New York, NY2006: 251-264
- Is dystonia a sensory disorder?.Ann Neurol. 1995; 38: 139-140
- Pathophysiology of writer's cramp.Hum Mov Sci. 2006; 25: 454-463
- Assessment of Primary Dystonias.Butterworths, Boston, MA1989
- Pathophysiological differences between musician's dystonia and writer's cramp.Brain. 2005; 128: 918-931
- The neurophysiology of focal hand dystonia in musicians.in: Altenmüller E. Wiesendanger K.M. Kesselring J. Music, Motor Control and the Brain. Oxford University Press, New York, NY2006: 266-284
- Human brain mapping in dystonia reveals both endophenotypic traits and adaptive reorganization.Ann Neurol. 2001; 50: 521-527
- Etiological musculo-skeletal factor in focal dystonia in a musician's hand: a case study of the right hand of a guitarist.Mov Disord. 2007; 51: 93-101
- Can peripheral trauma induce dystonia and other movement disorders? Yes!.Mov Disord. 2001; 16: 7-12
- The Brain That Changes Itself.Penguin Group, New York2007
- A primate genesis model of focal hand dystonia and repetitive strain injury: I. Learning-induced dedifferentiation of the representation of the hand in the primary somatosensory cortex in adult monkeys.Neurology. 1996; 47: 508-520
- A primate model for studying focal dystonia and repetitive strain injury: effects on the primary somatosensory cortex.Phys Ther. 1997; 77: 269-284
- Alteration of digital representations in somatosensory cortex in focal hand dystonia.Neuroreport. 1998; 9: 3571-3575
- The Motor Representation in Pianists and String Players.Oxford University Press, New York2006
- Somatosensory representation of the digits and clinical performance in patients with focal hand dystonia.Am J Phys Med Rehabil. 2003; 82: 737-749
- Abnormal associative plasticity of the human motor cortex in writer's cramp.Brain. 2003; 126: 2586-2596
- Homeostatic-like plasticity of the primary motor hand area is impaired in focal hand dystonia.Brain. 2005; 128: 1943-1950
- Brain Activation During String Playing.Oxford University Press, New York2006
- Brain Activation During Piano Playing.Oxford University Press, New York2006
- Abnormal somatosensory homunculus in dystonia of the hand.Ann Neurol. 1998; 44: 828-831
- Sensory representation abnormalities that parallel focal hand dystonia in a primate model.Somatosens Mot Res. 2002; 19: 347-357
- Representational cortex in musicians. Plastic alterations in response to musical practice.Ann N Y Acad Sci. 2001; 930: 300-314
- Task-specific hand dystonia: can too much plasticity be bad for you?.Trends Neurosci. 2006; 29: 192-199
- Impairment of cortical inhibition in writer's cramp as revealed by changes in electromyographic silent period after transcranial magnetic stimulation.Neurosci Lett. 1997; 222: 167-170
- Increased co-activation of the upper limb muscles in writer's cramp.J Neurol Neurosurg Psychiatry. 1985; 48: 782-787
- Impaired brain GABA in focal dystonia.Ann Neurol. 2002; 51: 93-101
- Sensory deficits in dystonia and their significance.Adv Neurol. 2004; 94: 11-17
- Cerebral activation patterns in patients with writer's cramp: a functional magnetic resonance imaging study.J Neurol. 2001; 248: 10-17
- Deficient activation of the motor cortical network in patients with writer's cramp.Neurology. 1999; 53: 96-105
- Computational model of the role of sensory disorganization in focal task specific dystonia.J Neurophysiol. 2000; 84: 2458-2464
- Abnormalities of spatial and temporal sensory discrimination in writer's cramp.Mov Disord. 2001; 16: 94-99
- Disturbances of grip force behavior in focal hand dystonia: evidence for a generalized impairment of sensory motor integration?.J Neurol Neurosurg Psychiatry. 2005; 76: 953-959
- Abnormalities of spatial discrimination in focal and generalized dystonia.Brain. 2003; 126: 2175-2182
- Abnormal premovement gating of somatosensory input in writer's cramp.Brain. 2000; 126: 2586-2596
- Reciprocal inhibition between forearm muscles in patients with writer's cramp and other occupational cramps, symptomatic hemidystonia and hemiparesis due to stroke.Brain. 1997; 112: 681-697
- Reduced intracortical inhibition and facilitation of corticospinal neurons in musicians.Exp Brain Res. 2002; 144: 336-342
- Increased basal-ganglia activation performing a non-dystonia-related task in focal dystonia.Eur J Neurol. 2008; 15: 831-838
- Impaired sensory motor integration during grasping in writers cramp.Brain. 1996; 229: 569-683
- Abnormal cortical mechanisms of voluntary muscle relaxation in patients with writer's cramp: an fMRI study.Brain. 2002; 125: 895-903
- The basal ganglia are hyperactive during the discrimination of tactile stimuli in writer's cramp.Brain. 2006; 129: 2697-2708
- Task-dependent intracortical inhibition is impaired in focal hand dystonia.Mov Disord. 2005; 20: 545-551
- Abnormal cortical sensory activation in dystonia: an fMRI study.Mov Disord. 2003; 18: 673-682
- Changes in the balance between motor cortical excitation and inhibition in focal, task specific dystonia.J Neurol Neurosurg Psychiatry. 1995; 59: 304-315
- Voxel based morphometry reveals specific gray matter changes in primary dystonia.Mov Disord. 2007; 22: 1538-1542
- Role of intracortical inhibition in selective hand muscle activation.J Neurophysiol. 2003; 89: 2013-2020
- Temporal discrimination of two passive movements in writer's cramp.Mov Disord. 2006; 21: 1131-1135
- Changes in motor cortical excitability induced by paired associative stimulation.Clin Neurophysiol. 2003; 114: 1437-1444
- Treatment of dystonia.Lancet Neurol. 2006; 5: 864-872
- Botulinum toxin does not reverse the cortical dysfunction associated with writer's cramp. A PET study.Brain. 1997; 120: 571-582
- Botulinum toxin therapy of writer's cramp.Eur J Neurol. 2006; 13: 55-59
- Variability of immunologic and clinical response in dystonic patients immunoresistant to botulinum toxin injections.Mov Disord. 1998; 13: 150-154
- Response and immunoresistance to botulinum toxin injections.Neurology. 1995; 45: 1743-1746
- Long-term efficacy of botulinum toxin A in treatment of various movement disorders over a 10-year period.Mov Disord. 2002; 17: 1288-1293
- Safety of botulinum toxin type A: a systematic review and meta-analysis.Curr Med Res Opin. 2004; 20: 981-990
- Factors predicting improvement in motor disability in writer's cramp treated with botulinum toxin.J Neurol Neurosurg Psychiatry. 2004; 75: 1688-1691
- Dystonia: medical therapy and botulinum toxin.in: Fahn S. Hallett M. DeLong D.R. Dystonia 4: Advances in Neurology. vol 94. Lippincott, Williams and Wilkins, Philadelphia2004: 275-286
- Ulnar neuropathy and dystonic flexion of the fourth and fifth digits: clinical correlation in musicians.Muscle Nerve. 1996; 19: 431-437
- Psychological approach to focal dystonia in musicians.(Commerce Place, 350 Main Street, Malden, MA 02148, USA)in: Tubiana R. Camadio P. Medical Problems of the Instrumental Musician. Martin Dunitz/Blackwell Science Inc., London2000
- Medical Problems of the Instrumentalist Musician.(Commerce Place, 350 Main Street, Malden, MA 02148, USA)1st ed. Martin Dunitz/Blackwell Science Inc., United Kingdom2000
- Modified pen grip in the treatment of writer's cramp: training-induced changes of handwriting kinematics and writing pressure in patients with writer's cramp.Hum Mov Sci. 2006; 25: 464-473
- Effective behavioral treatment of focal hand dystonia in musicians alters somatosensory cortical organization.Proc Natl Acad Sci U S A. 2003; 100: 7942-7946
- Changing the brain through therapy for musicians' hand dystonia.Ann N Y Acad Sci. 2005; 1060: 335-342
- The treatment of writer's cramp with multimodal behavior therapy and biofeedback: a study of 25 cases.Br J Psychiatry. 1983; 142: 180-183
- Specific muscle EMG biofeedback for hand dystonia.Appl Psychophysiol Biofeedback. 1999; 24: 267-280
- Does long-term physical exercise counteract age-related Purkinje cell loss? A stereological study of rat cerebellum.J Comp Neurol. 2000; 428: 213-222
- Exercise for older women: a training method and its influences on physical and cognitive performance.Eur J Appl Physiol Occup Physiol. 1992; 64: 460-466
- Improvement of cognitive function by mental and/or individualized aerobic training healthy elderly subjects.Int J Sports Med. 2002; 23: 415-421
- Effects of physical conditioning on information-processing efficiency.Percept Mot Skills. 1987; 65: 175-186
- The upside of aging.Wall Street Journal. 2007 Feb 17;
- Neuro-physiological adaptations associated with cross-education of strength.Brain Topogr. 2007; 20: 77-88
- Treatment effectiveness of patients with a history of repetitive strain injury and focal hand dystonia: a planned, prospective follow up study.J Hand Ther. 2000; 13: 289-301
- Effect of sensory discrimination training on structure and function in patients with focal hand dystonia: a case series.Arch Phys Med Rehabil. 2003; 84: 1505-1514
- The development of focal dystonia in musicians as a consequence of maladaptive plasticity: implications for intervention.in: Altenmuller E. Mario W. Kesselring J. Music, Motor Control and the Brain. Oxford University Press, New York2006: 293-308
- Sensorimotor reorganization by proprioceptive training in musician's dystonia and writer's cramp.Neurology. 2008; 22: 304-315
- Does training improve writer's cramp: an evaluation of a behavioral treatment approach using kinematic analysis.J Hand Ther. 2004; 17: 349-363
- Sensory training for patients with focal hand dystonia.Ann Neurol. 2002; 51: 593-598
- Sensory training as treatment for focal hand dystonia: a 1-year follow-up.Mov Disord. 2003; 18: 1044-1047
- Motor re-training does not need to be task specific to improve writer's cramp.Mov Disord. 2008; 23: 2319-2327
- Motor training as treatment in focal hand dystonia.Mov Disord. 2005; 20: 335-341
- The impact of long term exercise training on psychological function in older adults.J Gerontol. 1993; 48: 12-17
- Potential therapeutic effects of exercise to the brain.Curr Med Chem. 2007; 14: 2564-2571
- Brain fitness news.Posit Science. January 2008; : 1-3
- Physical activity and dementia risk in the elderly: findings from a prospective Italian study.Neurology. 2008; 70: 1786-1794
Potter N, Bain, J. Video games help elderly drivers. ABC News. Accessed Oct 27, 2008.
Zelinski E. Brain exercises sharpen memory in older adults. Paper presented at the American Gerontological Society, Nov 19, 2007, San Francisco.
- Effectiveness of sensory and motor rehabilitation of the upper limb following the principles of neuroplasticity: patients stable poststroke.Neurorehabil Neural Repair. 2003; 17: 176-191
- Differences in somatosensory hand organization in a healthy flutist and a flutist with focal hand dystonia: a case report.J Hand Ther. 2000; 13: 302-309
- The sensory consequences of repetitive strain injury in musicians: focal dystonia of the hand.J Back Musculoskeletal Rehabil. 1996; 7: 27-39
- Stopwatch for measuring thumb movement time.Percept Mot Skills. 1995; 81: 211-216
- The Byl-Cheney-Boczai sensory discriminator: reliability, validity, and responsiveness for testing stereognosis.J Hand Ther. 2002; 15: 315-330
- Functional outcomes: the development of a new instrument to monitor the effectiveness of physical therapy.Eur J Phys Med Rehabil. 1997; 7: 31-41
- Sensory Integration and Praxis Test.Western Psychological Services, Los Angeles, CA1989
- Muscles: Testing and Function.Williams and Wilkins, Baltimore, MD1993
TEC. Jamar dynamometer. 60 Page Road, Clifton, NJ 07012, USA.
- Available at:) (Microfet dynamometer-ergoFET 300) (
- Memory enhancement in healthy older adults using a brain plasticity based training program: a randomized controlled study.PNAS. 2006; 103: 12523-12528
- Brain plasticity and functional losses in the aged: scientific bases for a novel intervention.Prog Brain Res. 2006; 157: 81-109
- Principles of neuroplasticity.(chapter 26)in: Gonzalez E.G. Myers S.J. Edelstein J.L. Lieberman J.S. Downey J.A. Physiological Basis of Rehabilitation. Butterworth and Heinemann, Boston, MA2000: 609-628
- Focal Hand Dystonia. vol 2. Williams and Wilkins, Philadephia, PA2001
- Principles of experience-dependent neural plasticity: implications for rehabilitation after brain damage.J Speech Lang Hear Res. 2008; 51: S225-S239
- Repetitive stress pathology: soft tissue injuries.(chapter 22)in: Magee D.J. Zachazewski J.E. Quillen W.S. Pathology and Intervention in Musculoskeletal Rehabilitation. 2nd ed. Saunders Elsevier, New York2008: 707-749
- Effect of intensity of rehabilitation on recovery in patients stable post stroke.Neural Rehabil Neural Repair. 2008; 22: 494-504
- Experimental and Quasi-Experimental Designs for Research.Houghton Mifflin Company, Boston, MA1963
- Statistical Methods for the Social and Behavioral Sciences.WH Freeman and Company, New York1988
- Effect of constraint-induced movement therapy on upper extremity function 3 to 9 months after stroke: the EXCITE randomized clinical trial.JAMA. 2006; 296: 2095-2104
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
- a.
- #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
- a.
- #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
- a.
- #4.The home program included ____ forms of intervention
- a.3
- b.4
- c.5
- d.6
- a.
- #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
- a.
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Article info
Publication history
Published online: March 16, 2009
Identification
Copyright
© 2009 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.