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Eckart Altenmüller - One of the best experts on this subject based on the ideXlab platform.
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aberrant somatosensory motor adaptation in musicians dystonia
Movement Disorders, 2020Co-Authors: Shinichi Furuya, Eckart AltenmüllerAbstract:BACKGROUND: Some forms of movement disorders are characterized by Task-specific manifestations of symptoms. However, its underlying mechanisms are poorly understood. Here we addressed this issue through a novel motor adaptation experimental paradigm. METHODS: Pianists with and without Focal Task-specific dystonia learned to play the piano with a key whose weight can be modified by a novel robot system. RESULTS: The result clearly demonstrated a significantly larger error between the target and produced keystroke velocities in the patients than the controls following a repetition of keystrokes of the weighted key. This adaptation failure was not correlated with the variability of timing and velocity of the keystroke when the patients were playing unloaded piano keys, which suggests distinct effects of Focal Task-specific dystonia on motor adaptation and fine motor control. Immediately after a repetition of the strikes of the heavy key with keeping the fingers adducted, the error of the keystroke velocity when striking the key with the fingers more abducted was maintained in both the patients and controls. This generalization of the adaptation across different hand postures suggests that motor memory of dynamics of the piano key is independent of biomechanical properties of the hand. Importantly, a lack of difference in the finger muscular strength between the groups indicated that the adaptation failure was not attributed to deficit of muscular strength in the patients. CONCLUSIONS: These findings suggest that Task-specific manifestation of dystonic movements in Focal Task-specific dystonia is associated with malfunctions of internal representation of mechanical properties of a well-trained tool. (c) 2020 International Parkinson and Movement Disorder Society.
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Aberrant somatosensory–motor adaptation in musicians' dystonia
Movement disorders : official journal of the Movement Disorder Society, 2020Co-Authors: Shinichi Furuya, André Lee, Takanori Oku, Eckart AltenmüllerAbstract:BACKGROUND Some forms of movement disorders are characterized by Task-specific manifestations of symptoms. However, its underlying mechanisms are poorly understood. Here we addressed this issue through a novel motor adaptation experimental paradigm. METHODS Pianists with and without Focal Task-specific dystonia learned to play the piano with a key whose weight can be modified by a novel robot system. RESULTS The result clearly demonstrated a significantly larger error between the target and produced keystroke velocities in the patients than the controls following a repetition of keystrokes of the weighted key. This adaptation failure was not correlated with the variability of timing and velocity of the keystroke when the patients were playing unloaded piano keys, which suggests distinct effects of Focal Task-specific dystonia on motor adaptation and fine motor control. Immediately after a repetition of the strikes of the heavy key with keeping the fingers adducted, the error of the keystroke velocity when striking the key with the fingers more abducted was maintained in both the patients and controls. This generalization of the adaptation across different hand postures suggests that motor memory of dynamics of the piano key is independent of biomechanical properties of the hand. Importantly, a lack of difference in the finger muscular strength between the groups indicated that the adaptation failure was not attributed to deficit of muscular strength in the patients. CONCLUSIONS These findings suggest that Task-specific manifestation of dystonic movements in Focal Task-specific dystonia is associated with malfunctions of internal representation of mechanical properties of a well-trained tool. © 2020 International Parkinson and Movement Disorder Society.
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sonographic alteration of lenticular nucleus in Focal Task specific dystonia of musicians
Neurodegenerative Diseases, 2012Co-Authors: Uwe Walter, Franziska Buttkus, Reiner Benecke, Annette Grossmann, Dirk Dressler, Eckart AltenmüllerAbstract:Background/Aims: In distinct movement disorders, transcranial sonography detects alterations of deep brain structures with higher sensitivity than other neuroimaging methods. Lenticular nucleus hyperechogenicity on transcranial sonography, thought to be caused by increased local copper content, has been reported as a characteristic finding in primary spontaneous dystonia. Here, we wanted to find out whether deep brain structures are altered in Task-specific dystonia. Methods: The frequency of sonographic brainstem and basal ganglia changes was studied in an investigator-blinded setting in 15 musicians with Focal Task-specific hand dystonia, 15 musicians without dystonia, and 15 age- and sex-matched nonmusicians without dystonia. Results: Lenticular nucleus hyperechogenicity was found in 12 musicians with Task-specific dystonia, but only in 3 nondystonic musicians (Fisher’s exact test, p = 0.001) and 2 nonmusicians (p Conclusions: Our findings support the idea of a pathogenetic link between primary spontaneous and Task-specific dystonia. Sonographic basal ganglia alteration might indicate a risk factor that in combination with extensive fine motor training promotes the manifestation of Task-specific dystonia.
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Etiology of musician’s dystonia: Familial or environmental?
Neurology, 2009Co-Authors: Alexander H. Schmidt, Eckart Altenmüller, Hans-christian Jabusch, J. Hagenah, Norbert Brüggemann, Katja Lohmann, L. Enders, Patricia L. Kramer, Rachel Saunders-pullman, Susan BressmanAbstract:Objective: To test the hypothesis that there is familial aggregation of dystonia and other movement disorders in relatives of patients with musician’s dystonia (MD) and to identify possible environmental triggers. Methods: The families of 28 index patients with MD (14 with a reported positive family history of Focal Task-specific dystonia [FTSD] and 14 with no known family history [FH−]) underwent a standardized telephone screening interview using a modified version of the Beth Israel Dystonia Screen. Videotaped neurologic examinations were performed on all participants who screened positive and consensus diagnoses established. All patients were investigated for DYT1 dystonia and suitable families were tested for linkage to DYT7 . All family members were administered questionnaires covering potential triggers of FTSD. Results: A diagnosis of dystonia was established in all 28 index patients and in 19/97 examined relatives (MD: n = 8, other FTSD: n = 9, other dystonias: n = 2), 5 of whom were members of FH− families. In 27 of the 47 affected individuals, additional forms of dystonia were seen; other movement disorders were observed in 23 patients. In total, 18 families were multiplex families with two to four affected members. Autosomal dominant inheritance was compatible in at least 12 families. The GAG deletion in DYT1 was absent in all patients. Linkage to DYT7 could be excluded in 1 of the 11 informative families. With respect to potential environmental triggers, there was no significant difference between patients with MD/FTSD compared to unaffected family members. Conclusion: Our results suggest a genetic contribution to musician’s dystonia with phenotypic variability including Focal Task-specific dystonia. BIDS = Beth Israel Dystonia Screen; FH+ = reported positive family history of Focal Task-specific dystonia; FH− = no known family history of Focal Task-specific dystonia; FTSD = Focal Task-specific dystonia; MD = musician’s dystonia; WC = writer’s cramp.
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Etiology of musician's dystonia: familial or environmental?
Neurology, 2009Co-Authors: Alexander H. Schmidt, Eckart Altenmüller, Hans-christian Jabusch, J. Hagenah, Norbert Brüggemann, Katja Lohmann, L. Enders, Patricia L. Kramer, Rachel Saunders-pullman, Susan BressmanAbstract:Objective: To test the hypothesis that there is familial aggregation of dystonia and other movement disorders in relatives of patients with musician’s dystonia (MD) and to identify possible environmental triggers. Methods: The families of 28 index patients with MD (14 with a reported positive family history of Focal Task-specific dystonia [FTSD] and 14 with no known family history [FH−]) underwent a standardized telephone screening interview using a modified version of the Beth Israel Dystonia Screen. Videotaped neurologic examinations were performed on all participants who screened positive and consensus diagnoses established. All patients were investigated for DYT1 dystonia and suitable families were tested for linkage to DYT7 . All family members were administered questionnaires covering potential triggers of FTSD. Results: A diagnosis of dystonia was established in all 28 index patients and in 19/97 examined relatives (MD: n = 8, other FTSD: n = 9, other dystonias: n = 2), 5 of whom were members of FH− families. In 27 of the 47 affected individuals, additional forms of dystonia were seen; other movement disorders were observed in 23 patients. In total, 18 families were multiplex families with two to four affected members. Autosomal dominant inheritance was compatible in at least 12 families. The GAG deletion in DYT1 was absent in all patients. Linkage to DYT7 could be excluded in 1 of the 11 informative families. With respect to potential environmental triggers, there was no significant difference between patients with MD/FTSD compared to unaffected family members. Conclusion: Our results suggest a genetic contribution to musician’s dystonia with phenotypic variability including Focal Task-specific dystonia. BIDS = Beth Israel Dystonia Screen; FH+ = reported positive family history of Focal Task-specific dystonia; FH− = no known family history of Focal Task-specific dystonia; FTSD = Focal Task-specific dystonia; MD = musician’s dystonia; WC = writer’s cramp.
Steven J. Frucht - One of the best experts on this subject based on the ideXlab platform.
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Transcranial magnetic stimulation therapy for Focal leg dystonia: a case report
Journal of clinical movement disorders, 2019Co-Authors: Kush Sharma, Steven J. Frucht, Alberto Cucca, Shashank Agarwal, Andrea O. Lee, Milton Cesar BiagioniAbstract:Dystonia is a debilitating disease that causes abnormal, often repetitive, movements, postures or both. The pathophysiology is unknown but related to loss of neuronal inhibition, aberrant sensorimotor integration, and/or derangements of synaptic plasticity. Current treatments include pharmacotherapy, botulinum toxin injections and deep brain stimulation (DBS). The response to these treatments are often limited and carry the risk of side effects requiring alternative therapies such as non-invasive brain stimulation. We present a case report of a 65-year -old man with refractory Focal ‘Task-specific’ dystonia. The treatment plan included 10-daily sessions of 1 Hz, 2600 pulses of repetitive transcranial magnetic stimulation (rTMS) targeting the primary motor cortex. There were no clinical benefits noticed. Currently, there are no rTMS protocol treatments for dystonia. Publication of negative results will help in refining the optimal stimulation parameters, thus maximizing the effectiveness and reproducibility of future therapeutic protocols.
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treatment of musicians dystonia
2019Co-Authors: Steven J. FruchtAbstract:Musicians’ dystonia is an example of a Focal Task-specific dystonia, i.e., dystonia affecting one part of the body, only when it is engaged in performance of a specific Task. Musicians’ dystonia may involve the upper extremity (either the hand, arm, or shoulder) or the embouchure (the muscles of lower face, tongue, and pharynx that control the flow of air into a brass or woodwind instrument). Musicians’ dystonia typically affects professionals at the peak of their performing careers, often with devastating consequences. Recent work has revealed that both genetic and environmental influences contribute to the development of the condition. Current treatments for musicians’ dystonia include instrument modification, physical therapy, oral medication, injection of botulinum toxin, and even stereotactic surgery. Management remains challenging, and there is a need for more innovative approaches for treatment.
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Velopharyngeal Dystonia: An Unusual Focal Task-specific Dystonia?
Tremor and other hyperkinetic movements (New York N.Y.), 2017Co-Authors: Amar Patel, Lucian Sulica, Steven J. FruchtAbstract:Background: Velopharyngeal dysfunction produces a nasal speech pattern because of the inability to close the nasal airway during speech, most often associated with anatomical abnormalities of the palate. Case Report: We describe two cases of possible velopharyngeal dystonia, a Task-specific movement disorder causing a speech pattern similar to velopharyngeal dysfunction. Both patients experienced treatment response with anticholinergic medication. Discussion: Dystonia affecting speech via involvement of the pharyngeal musculature may be an unrecognized etiology of voice disorders.
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Focal Task specific dystonia: a review and update
Journal of Neurology, 2017Co-Authors: Christine M. Stahl, Steven J. FruchtAbstract:In this review, we summarize recent advances in understanding the etiology, risk factors and pathophysiology of Focal Task specific dystonia (FTSD), movement disorders characterized by abnormal motor activation during the performance of specific, repetitive actions. We focus on two common FTSD, musician’s dystonia and writer’s cramp. FTSD may pose a threat to the patient’s livelihood, and improved therapeutic treatments are needed.
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Embouchure dystonia: a video guide to diagnosis and evaluation
Journal of clinical movement disorders, 2016Co-Authors: Steven J. FruchtAbstract:Embouchure dystonia is an unusual Focal Task-specific dystonia affecting the muscles that control the flow of air into the mouthpiece of a brass or woodwind instrument. The complexity of the embouchure and the relative rarity of the condition pose barriers for recognition and management of the disorder. Case review and video survey. This paper presents four video compilations that illustrate the rich phenomenology of embouchure dystonia, in order to enhance recognition and diagnosis. The phenomenology of embouchure dystonia is discussed.
Alberto J. Espay - One of the best experts on this subject based on the ideXlab platform.
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Writing Orthotic Device for the Management of Writer’s Cramp
Frontiers in Neurology, 2013Co-Authors: Narayanasarma V. Singam, Alok Dwivedi, Alberto J. EspayAbstract:Background: Oral therapies and chemodenervation procedures are often unrewarding in the treatment of Focal, Task-specific hand disorders such as writer's cramp or primary writing tremor. Methods: A portable writing orthotic device was evaluated on fifteen consecutively recruited writer's cramp and primary writing tremor subjects. We measured overall impairment at baseline and after two weeks of at-home use with the Writer’s Cramp Rating Scale (range = 0-8, higher is worse) and writing quality and comfort with a visual analog scale (range = 0-10). Results: Compared to regular pen, the writing orthotic device improved the Writer's Cramp Rating Scale scores at first-test (p=0.001) and re-test (p=0.005) as well as writing quality and device comfort in writer's cramp subjects. Benefits were sustained at two weeks. Primary writing tremor subjects demonstrated no improvements. Conclusions: Writing orthotic devices exploiting a muscle-substitution strategy may yield immediate benefits in patients with writer's cramp.
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writing orthotic device for the management of writer s cramp
Frontiers in Neurology, 2013Co-Authors: Narayanasarma V. Singam, Alok Kumar Dwivedi, Alberto J. EspayAbstract:Background: Oral therapies and chemodenervation procedures are often unrewarding in the treatment of Focal, Task-specific hand disorders such as writer's cramp or primary writing tremor. Methods: A portable writing orthotic device was evaluated on fifteen consecutively recruited writer's cramp and primary writing tremor subjects. We measured overall impairment at baseline and after two weeks of at-home use with the Writer’s Cramp Rating Scale (range = 0-8, higher is worse) and writing quality and comfort with a visual analog scale (range = 0-10). Results: Compared to regular pen, the writing orthotic device improved the Writer's Cramp Rating Scale scores at first-test (p=0.001) and re-test (p=0.005) as well as writing quality and device comfort in writer's cramp subjects. Benefits were sustained at two weeks. Primary writing tremor subjects demonstrated no improvements. Conclusions: Writing orthotic devices exploiting a muscle-substitution strategy may yield immediate benefits in patients with writer's cramp.
Shinichi Furuya - One of the best experts on this subject based on the ideXlab platform.
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aberrant somatosensory motor adaptation in musicians dystonia
Movement Disorders, 2020Co-Authors: Shinichi Furuya, Eckart AltenmüllerAbstract:BACKGROUND: Some forms of movement disorders are characterized by Task-specific manifestations of symptoms. However, its underlying mechanisms are poorly understood. Here we addressed this issue through a novel motor adaptation experimental paradigm. METHODS: Pianists with and without Focal Task-specific dystonia learned to play the piano with a key whose weight can be modified by a novel robot system. RESULTS: The result clearly demonstrated a significantly larger error between the target and produced keystroke velocities in the patients than the controls following a repetition of keystrokes of the weighted key. This adaptation failure was not correlated with the variability of timing and velocity of the keystroke when the patients were playing unloaded piano keys, which suggests distinct effects of Focal Task-specific dystonia on motor adaptation and fine motor control. Immediately after a repetition of the strikes of the heavy key with keeping the fingers adducted, the error of the keystroke velocity when striking the key with the fingers more abducted was maintained in both the patients and controls. This generalization of the adaptation across different hand postures suggests that motor memory of dynamics of the piano key is independent of biomechanical properties of the hand. Importantly, a lack of difference in the finger muscular strength between the groups indicated that the adaptation failure was not attributed to deficit of muscular strength in the patients. CONCLUSIONS: These findings suggest that Task-specific manifestation of dystonic movements in Focal Task-specific dystonia is associated with malfunctions of internal representation of mechanical properties of a well-trained tool. (c) 2020 International Parkinson and Movement Disorder Society.
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Aberrant somatosensory–motor adaptation in musicians' dystonia
Movement disorders : official journal of the Movement Disorder Society, 2020Co-Authors: Shinichi Furuya, André Lee, Takanori Oku, Eckart AltenmüllerAbstract:BACKGROUND Some forms of movement disorders are characterized by Task-specific manifestations of symptoms. However, its underlying mechanisms are poorly understood. Here we addressed this issue through a novel motor adaptation experimental paradigm. METHODS Pianists with and without Focal Task-specific dystonia learned to play the piano with a key whose weight can be modified by a novel robot system. RESULTS The result clearly demonstrated a significantly larger error between the target and produced keystroke velocities in the patients than the controls following a repetition of keystrokes of the weighted key. This adaptation failure was not correlated with the variability of timing and velocity of the keystroke when the patients were playing unloaded piano keys, which suggests distinct effects of Focal Task-specific dystonia on motor adaptation and fine motor control. Immediately after a repetition of the strikes of the heavy key with keeping the fingers adducted, the error of the keystroke velocity when striking the key with the fingers more abducted was maintained in both the patients and controls. This generalization of the adaptation across different hand postures suggests that motor memory of dynamics of the piano key is independent of biomechanical properties of the hand. Importantly, a lack of difference in the finger muscular strength between the groups indicated that the adaptation failure was not attributed to deficit of muscular strength in the patients. CONCLUSIONS These findings suggest that Task-specific manifestation of dystonic movements in Focal Task-specific dystonia is associated with malfunctions of internal representation of mechanical properties of a well-trained tool. © 2020 International Parkinson and Movement Disorder Society.
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Distinct roles of brain activity and somatotopic representation in pathophysiology of Focal dystonia.
Human brain mapping, 2018Co-Authors: Kazumasa Uehara, Shinichi Furuya, Hidemi Numazawa, Kahori Kita, Takashi Sakamoto, Takashi HanakawaAbstract:Two main neural mechanisms including loss of cortical inhibition and maladaptive plasticity have been thought to be involved in the pathophysiology of Focal Task-specific dystonia. Such loss of inhibition and maladaptive plasticity likely correspond to cortical overactivity and disorganized somatotopy, respectively. However, the most plausible mechanism of Focal Task-specific dystonia remains unclear. To address this question, we assessed brain activity and somatotopic representations of motor-related brain areas using functional MRI and behavioral measurement in healthy instrumentalists and patients with embouchure dystonia as an example of Focal Task-specific dystonia. Dystonic symptoms were measured as variability of fundamental frequency during long tone playing. We found no significant differences in brain activity between the embouchure dystonia and healthy wind instrumentalists in the motor-related areas. Assessment of somatotopy, however, revealed significant differences in the somatotopic representations of the mouth area for the right somatosensory cortex between the two groups. Multiple-regression analysis revealed brain activity in the primary motor and somatosensory cortices, cerebellum, and putamen was significantly associated with variability of fundamental frequency signals representing dystonic symptoms. Conversely, somatotopic representations in motor-related brain areas were not associated with variability of fundamental frequency signals in embouchure dystonia. The present findings suggest that abnormal motor-related network activity and aberrant somatotopy correlate with different aspects of mechanisms underlying Focal Task-specific dystonia.
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Aberrant cortical excitability reflects the loss of hand dexterity in musician's dystonia
The Journal of Physiology, 2018Co-Authors: Shinichi Furuya, Kazumasa Uehara, Takashi Sakamoto, Takashi HanakawaAbstract:Dystonia is a movement disorder characterized by abnormalities at multifaceted aspects of motor dexterity and neural functions. Evidence bridging between pathophysiology and movement abnormalities is limited. A novel finding was that in Focal Task-specific dystonia (FTSD), an aberrantly reduced inhibition at the motor cortex was related to the temporal imprecision of the dexterous finger movements, whereas an elevated facilitation was associated with an abnormally sluggish transition of finger movements from flexion to extension. We newly identified two sets of behavioural-physiological covariations as hallmarks of hand FTSD, which is clinically significant because these findings provide novel evidence connecting distinct types of malfunctions within the motor cortex at rest with distinct aspects of motor dexterity degradation in FTSD patients. Focal Task-specific dystonia (FTSD) compromises dexterous movements. A proposed pathophysiological mechanism of FTSD involves malfunction of the motor cortex (M1). However, no evidence is yet available regarding whether and how malfunctions of M1 are responsible for the loss of motor dexterity. Here, we addressed this issue by assessing both M1 excitability and detailed movement parameters, as well as their relationships. Transcranial magnetic stimulation was applied over M1 in 20 pianists with FTSD, 20 healthy pianists and 20 non-musicians. The patients demonstrated both reduced short-interval intracortical inhibition (SICI) and elevated intracortical facilitation (ICF) compared with the healthy controls. This indicates that the abnormal cortical excitability reflects pathophysiology but not current skills. Hand motor dexterity was evaluated by position sensors during piano playing at two tempi. The patients showed delayed transition from finger flexion to extension at the fastest tempo and greater timing variability of the finger movements. Furthermore, multivariate analyses identified distinct sets of covariation between cortical excitability and dexterity measures. Namely, the SICI measure and ICF measure were associated with the temporal variability of the movements and the quickness of the transition from flexion to extension, respectively. Specifically, the reduced inhibition and elevated facilitation at M1 in pianists was related to the temporal imprecision and impairment of quick transitions in the sequential finger movements. The present study provides novel evidence associating M1 malfunctions with dexterity loss. © 2018 The Authors. The Journal of Physiology © 2018 The Physiological Society.
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Aberrant cortical excitability reflects the loss of hand dexterity in musician's dystonia
The Journal of physiology, 2018Co-Authors: Shinichi Furuya, Kazumasa Uehara, Takashi Sakamoto, Takashi HanakawaAbstract:Key points Dystonia is a movement disorder characterized by abnormalities at multifaceted aspects of motor dexterity and neural functions. Evidence bridging between pathophysiology and movement abnormalities is limited. A novel finding was that in Focal Task-specific dystonia (FTSD), an aberrantly reduced inhibition at the motor cortex was related to the temporal imprecision of the dexterous finger movements, whereas an elevated facilitation was associated with an abnormally sluggish transition of finger movements from flexion to extension. We newly identified two sets of behavioural-physiological covariations as hallmarks of hand FTSD, which is clinically significant because these findings provide novel evidence connecting distinct types of malfunctions within the motor cortex at rest with distinct aspects of motor dexterity degradation in FTSD patients. Abstract Focal Task-specific dystonia (FTSD) compromises dexterous movements. A proposed pathophysiological mechanism of FTSD involves malfunction of the motor cortex (M1). However, no evidence is yet available regarding whether and how malfunctions of M1 are responsible for the loss of motor dexterity. Here, we addressed this issue by assessing both M1 excitability and detailed movement parameters, as well as their relationships. Transcranial magnetic stimulation was applied over M1 in 20 pianists with FTSD, 20 healthy pianists and 20 non-musicians. The patients demonstrated both reduced short-interval intracortical inhibition (SICI) and elevated intracortical facilitation (ICF) compared with the healthy controls. This indicates that the abnormal cortical excitability reflects pathophysiology but not current skills. Hand motor dexterity was evaluated by position sensors during piano playing at two tempi. The patients showed delayed transition from finger flexion to extension at the fastest tempo and greater timing variability of the finger movements. Furthermore, multivariate analyses identified distinct sets of covariation between cortical excitability and dexterity measures. Namely, the SICI measure and ICF measure were associated with the temporal variability of the movements and the quickness of the transition from flexion to extension, respectively. Specifically, the reduced inhibition and elevated facilitation at M1 in pianists was related to the temporal imprecision and impairment of quick transitions in the sequential finger movements. The present study provides novel evidence associating M1 malfunctions with dexterity loss.
Narayanasarma V. Singam - One of the best experts on this subject based on the ideXlab platform.
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Writing Orthotic Device for the Management of Writer’s Cramp
Frontiers in Neurology, 2013Co-Authors: Narayanasarma V. Singam, Alok Dwivedi, Alberto J. EspayAbstract:Background: Oral therapies and chemodenervation procedures are often unrewarding in the treatment of Focal, Task-specific hand disorders such as writer's cramp or primary writing tremor. Methods: A portable writing orthotic device was evaluated on fifteen consecutively recruited writer's cramp and primary writing tremor subjects. We measured overall impairment at baseline and after two weeks of at-home use with the Writer’s Cramp Rating Scale (range = 0-8, higher is worse) and writing quality and comfort with a visual analog scale (range = 0-10). Results: Compared to regular pen, the writing orthotic device improved the Writer's Cramp Rating Scale scores at first-test (p=0.001) and re-test (p=0.005) as well as writing quality and device comfort in writer's cramp subjects. Benefits were sustained at two weeks. Primary writing tremor subjects demonstrated no improvements. Conclusions: Writing orthotic devices exploiting a muscle-substitution strategy may yield immediate benefits in patients with writer's cramp.
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writing orthotic device for the management of writer s cramp
Frontiers in Neurology, 2013Co-Authors: Narayanasarma V. Singam, Alok Kumar Dwivedi, Alberto J. EspayAbstract:Background: Oral therapies and chemodenervation procedures are often unrewarding in the treatment of Focal, Task-specific hand disorders such as writer's cramp or primary writing tremor. Methods: A portable writing orthotic device was evaluated on fifteen consecutively recruited writer's cramp and primary writing tremor subjects. We measured overall impairment at baseline and after two weeks of at-home use with the Writer’s Cramp Rating Scale (range = 0-8, higher is worse) and writing quality and comfort with a visual analog scale (range = 0-10). Results: Compared to regular pen, the writing orthotic device improved the Writer's Cramp Rating Scale scores at first-test (p=0.001) and re-test (p=0.005) as well as writing quality and device comfort in writer's cramp subjects. Benefits were sustained at two weeks. Primary writing tremor subjects demonstrated no improvements. Conclusions: Writing orthotic devices exploiting a muscle-substitution strategy may yield immediate benefits in patients with writer's cramp.