Sensory motor retuning: A behavioral treatment for focal hand dystonia of pianists and guitarists Victor Candia, MA, Thomas Schäfer, Edward Taub, PhD,

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Sensory motor retuning: A behavioral treatment for focal hand dystonia of pianists and guitarists Victor Candia, MA, Thomas Schäfer, Edward Taub, PhD, Harald Rau, PhD, Eckart Altenmüller, MD, Brigitte Rockstroh, PhD, Thomas Elbert, PhD Archives of Physical Medicine and Rehabilitation Volume 83, Issue 10, Pages 1342-1348 (October 2002) DOI: 10.1053/apmr.2002.35094 Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 1 Splint device used to immobilize fingers of the dystonic hand. (A) The device was tailored to the dimensions of each individual's hand and the requirements of the instrument he/she played. (B) Hand in splint with D2 immobilized. Archives of Physical Medicine and Rehabilitation 2002 83, 1342-1348DOI: (10.1053/apmr.2002.35094) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 2 Mean DES ratings of all 11 patients for the pre- and posttreatment and last follow-up periods. Rating scale: 0, dystonia as bad as at its worst; 1, slightly improved; 2, moderately improved; 3, almost normal; and 4, normal. Archives of Physical Medicine and Rehabilitation 2002 83, 1342-1348DOI: (10.1053/apmr.2002.35094) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 3 Scatterplot of pre- to posttreatment change for the DES and for the fast Fourier transform (FFT) power values for spectral analysis of dexterity and displacement device performance (which gives the smoothness of movement) for the focal dystonic fingers. Archives of Physical Medicine and Rehabilitation 2002 83, 1342-1348DOI: (10.1053/apmr.2002.35094) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 4 The extent and duration of the movements of the focal dystonic (D4, dark line) and maximal compensatory finger (D5, light line) of the dystonic hand and the corresponding fingers of the nondystonic hand in patient 6 recorded during and after treatment. Each record is for the last 10 seconds of the first exercise, which was the same at the 2 time points and for both hands. Note the improvement in the dystonic hand (panels 1, 3). Archives of Physical Medicine and Rehabilitation 2002 83, 1342-1348DOI: (10.1053/apmr.2002.35094) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig. 5 The hands of a pianist playing the same passage (A) before and (B) after treatment. The lines outline the flexor spasm of right D3, D4, and D5 before treatment and the correct positioning after treatment. Archives of Physical Medicine and Rehabilitation 2002 83, 1342-1348DOI: (10.1053/apmr.2002.35094) Copyright © 2002 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions