Focal Dystonia of the Hand

The whole article (24 pages) was pubished in the issues of August and September 2013 in the "Classical Guitar Magazine" in London. Here are the first few pages. The whole article will be available here after the publication.

A Classical Guitarist’s Story of

Recovery from Focal Dystonia,

or Musician’s Focal Dystonia of the Hand

Dr. Apostolos Paraskevas

ABOUT THE AUTHOR

Apostolos Paraskevas is a classical guitarist and composer as well as an award-winning film director and producer. He has received multiple international awards for his compositions and was nominated for a Grammy Award. He is the only guitarist ever to have a major orchestral piece performed at Carnegie Hall––and the only musician who has performed there in a Grim Reaper outfit. He has made over a dozen recordings of his music. He served for 16 years as the artistic director of the International Guitar Congress on the island of Corfu, Greece. Recent appearances have included concerts in the U.S. at Carnegie Hall and Weill Hall, and abroad in St. Petersburg, Athens, and Germany. Apostolos is a Professor of Composition and Classical Guitar at Berklee College of Music in Boston. Visit his website at http://apostolosparaskevas.com

ABSTRACT: I was struck almost overnight by focal dystonia (FD) to my right hand after a concert. I invested close to 7,000 hours in successful self-rehabilitation over a period of four years and am now symptom free. My rehabilitation was based on reducing tension in my hand and retraining my brain through proper, relaxed hand movements, practiced extensively. In this article I share my path to recovery in hopes of helping other musicians with FD.

Disclaimer: This article describes my own personal perceptions of and experience with focal dystonia. No information in this article should be taken as medical advice.

THE MUSICIAN’S WORST FEAR

One evening in April 2009 I presented a concert at Carnegie Hall, my fourth there since 1994. On that night I performed three of my own guitar concertos, both solo and chamber music. It was a long program, but all went well. I felt nothing out of the ordinary with my hands. For the next couple of days I didn’t practice at all, but I felt vague weakness in my right hand. This didn’t alarm me as it might be expectable after a concert.

A few days later I was trying to show a student at Berklee College of Music, where I’ve taught composition and guitar since 2001, how to do a simple arpeggio by playing the Romanza. Suddenly I realized to my dismay that something was severely wrong. I couldn’t move the fingers of my right hand freely and my ring finger was curling in toward my palm.

This was the most frightening feeling I have ever experienced in my career as a classical guitarist. I knew instantly that I was in serious trouble. I was mystified as to how this had occurred and I felt deep distress wondering how long it would last and how it would impact my career.

I immediately sought help from neurologists and hand surgeons. The first doctor couldn’t find anything wrong with me anatomically and he sent me on my way. The second one, a neurologist, directed a clinic specifically for musicians’ injuries at Brigham and Women’s Hospital in Boston and had seen this condition before. He diagnosed me with focal dystonia (FD) in April 2009 and my long adventure with understanding and overcoming this condition began.

Focal dystonia is a neurological condition that causes muscle contractions and abnormal positions. “Dystonia” means an impairment in muscle tone. “Focal” means it only affects one part of the body. When it happens to the hand, the fingers curl inward toward the palm or they extend outward, making precise movements impossible. When you flex one muscle, like a specific finger, other muscles flex unintentionally at the same time. There is no pain involved in this condition, but it can last for decades if not treated properly.

Although FD can happen to people in any profession who use repetitive hand movements, there are many more cases among musicians. It can happen to pianists, guitarists, and string, woodwind, brass, and percussion players. In woodwind and brass players it affects the mouth, cheeks, jaw, and tongue. About one to two percent of professional musicians have FD. Most of them are classically trained. Romantic composer Robert Schumann had the first known case of musician’s FD. He composed the Toccata Opus 7 to completely avoid using his afflicted right middle finger. His letter to his future wife Klara Wieck in 1891 conveys the emotional turmoil of FD:

It often grieves me, especially here in Vienna, that I have a disabled hand. And to you I will admit that it grows worse and worse. I have often complained to heaven about it and asked “God, why did you do this, of all things, to me?” For here it would be so particularly useful, all kinds of music are so formed and alive within me, and I long to breathe them out lightly; and I can only drag them out when absolutely necessary, stumbling with one finger after the other. It is quite dreadful, and has already caused me much distress.

A notable contemporary example is pianist Leon Fleisher. He had FD for 40 years and during that time he played only with his left hand. In his eighties he returned to playing with both hands after Botox treatment, but in a 2007 interview with the New York Times he said, “I would like to make it clearly understood that I have not been cured of FD. A way has been found to ameliorate the symptoms.”

A FRUSTRATING SEARCH FOR ANSWERS

I read as much as I could about FD and found that researchers had not yet found the real cause or the cure. I discovered that there were many different opinions about the cause and treatment among doctors, researchers, and players. Some claimed that it is psychological in origin; some said that it’s a neurological problem; and some viewed it as a technical issue. Some approach FD in a more global and general way (from the whole body/brain to the hands), while others approach it in a more detailed and localized way (from the hands to the brain)....

FOCAL DYSTONIA OF THE HAND IS A REVERSIBLE CONDITION THAT REQUIRES NO DRUGS NOR DOCTORS BUT ATTENTION TO UNCONSCIOUS BEHAVIORAL HABITS AND RE-CONSTRUCTING TECHNIQUE.

The whole article was published in the summer of 2013 on the "Classical Guitar Magazine" in London in two parts.