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Dr. Teresa Dybvig, Director

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Can retraining help pianists with dystonia play again?

A message from Well-Balanced Pianist Director Teresa Dybvig

Yes.

Over the years I have seen that pianists (and other instrumentalists) with focal hand dystonia share certain incoordinate habits of alignment, balance, and movement. When these habits are changed to more coordinate habits, the involuntary movement that characterizes the dystonia ameliorates or disappears altogether. To see before-and-after photos of a few of these habits, you can view a poster I made in 2007. My thoughts are more precise now than they were then, but it will still give you an idea about the habits I'm referring to.

I have also observed that people with hand/arm tremors from unknown causes (called "idiopathic" or "essential" tremor) share those same habits. Their situations also improve when they improve the quality of their movement. For that reason, I tend to speak in terms of pianists with involuntary movements rather than limiting my comments to pianists with dystonia. An involuntary movement is any unwanted movement that the musician feels he or she cannot control. Focal hand dystonia is one type of involuntary movement. Tremors are another.

When saying "pianists with involuntary motions" I refer to a condition that occurs later in life, after the pianist has been playing for several years, for which there is no other known cause (many diseases, like Parkinson's Disease, cause involuntary movements). Dystonia and tremors that have been present since birth are different situations.

It is noteworthy that all the pianists I see with involuntary movements have similar habits. Usually every student who comes to me to learn healthy movement walks in the door with a unique combination of healthy and unhealthy habits. So it is extraordinary when every student with a particular problem evinces the same habits.

Some music medicine doctors are not fans of retraining. I don't know why, but I have some ideas. For one, those of us who do the retraining have such a different educational background that we barely speak the same language as physicians. Morever, we do not tend to think quantitatively, or do quantitative research. My experience also indicates that many doctors cannot imagine that piano teachers know anything about a physical condition.

And sometimes they are right to be skeptical: judging from some students I've seen, the retraining some teachers do is too imprecise to be helpful. Sometimes teachers even seem to have recommend damaging movements or positions that increase isolation. So even though I find a generalized attitude against retraining frustrating, I can understand why it exists. If music medicine researchers understood that there are different approaches to retraining, fascinating research could be done to determine which approaches were most effective. Then we could begin to see a real change for musicians with involuntary movements!

Other medical experts consider retraining an important component of treating musicians with involuntary movements. One of my students told me that when Dr. John Chong of Toronto diagnosed her with dystonia, he advised her to find a Taubman teacher and learn to play differently. Dr. Eckart Altenmüller (2003, full citation below), director of the Institute of Music Physiology and Musicians’ Medicine in Hannover, Germany; Raoul Tubiana (2003), director of the Parisian l'Institut de la Main; and Altenmüller together with Hans-Christian Jabusch (2006), also at Hannover, all advocate retraining as part of treatment programs to help musicians with dystonia.

Still, some neurologists tell musicians that a diagnosis of dystonia, or essential tremor, or idiopathic tremor, means that their best playing is behind them. These musicians hear that even if one of the medications that address involuntary movements helps them, they still will not return to their previous level of performance. My experience supports a more optimistic prognosis. I have seen that pianists with dystonia and other involuntary movements who retrain can become even better pianists than they were before their injury appeared. Those who persist can play real music without experiencing the involuntary movement after 20 or 30 hours of lessons. Sometimes they are so happy to play without the involuntary movement that they stop lessons at this point. Others continue to take lessons so they can play increasingly complex repertoire well and without trouble. They become greedy in the best way.

Sometimes students considering retraining worry that they will find it hard. They might. Retraining requires clear thinking, honesty, and persistence. But to judge from my students, they will probably also find it empowering and rewarding. Some ask how old they will be when they are playing again. Obviously, they will be as old as they would be if they didn't retrain, but they will have pursued the more proactive course. Some are so discouraged by what they hear from their doctors that they decide that giving up is the most realistic course. But there is nothing inherently more realistic about pessimism. Just because your doctor hasn't had good experience with retraining, or doesn't know how to guide you through retraining, does not mean that retraining isn't a solution. It's just not your doctor's solution.

I'm going to offer you some advice, which you should take only if it seems right to you. I believe that all of us know, inside, what is our best course. We know even if we don't like it. So if you think retraining might be an option, try it. You're not committed for life. Give it a good space of time -- say, a year, or 20 or 30 hours of lessons, and commit to it on every level. Wait until that time period is over before you assess how it's going. (I've noticed that my dystonia students often stop and asses every 5 minutes, and this makes it understandably hard to concentrate.) Be aware that for a while, it may not seem like you're addressing your involuntary movement in lessons. Don't worry about that. You don't get your body parts to move well by ordering them about, you get them to move well by creating the right conditions.

If you have read this far, you are hoping for an answer. If you're willing to make the effort on your own behalf, retraining is an answer.

References

Altenmüller, Eckart (2003). Focal dystonia: advances in brain imaging and understanding of fine motor control in musicians. Hand Clinics 19: 1-16.

Jabusch, H., and Altenmüller, E. (2006). Focal dystonia in musicians: from phenomenology to therapy. Advances in Cognitive Psychology 2(2):207-220.

Tubiana, R. (1997). Upper limb disorders in musicians. Maîtrise Orthopédique 69.

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What students say

"Some days I wake up and I don't even remember which hand had the dystonia..." read more

"A friend recently heard me play the Liszt Tarantella and said, 'I would never have guessed you were injured...'" read more

"Now, after three years of working with Teresa, I am playing "real repertoire" -- Chopin nocturnes and Rachmaninoff preludes....'" read more

"...Today I don't even consider myself a person with dystonia." read more

Read more comments from students about The Well-Balanced Pianist program and faculty



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