Musicians focal dystonia: the practitioner’s perspective on psychological, psychosocial, and behavioural risk factors and non-motor symptoms

Musician’s focal dystonia (MFD) is a painless, task-specific neurological movement disorder that impairs fine motor control when playing an instrument. The pathophysiology is not fully understood, and while the available treatment strategies can help with improving motor control, they are rarely able to fully and reliably rehabilitate playing skills. Recent studies suggest that apart from genetic factors, maladaptive neuroplasticity, and the repetitive nature of the instrumental technique, psychosocial, psychological, and behavioural factors might also play a role in the onset of MFD. However, the presence of some of these risk factors is supported primarily by anecdotal evidence, with only a few aspects examined empirically. To explore this area further, 14 semi-structured interviews were conducted with a convenience sample of practitioners (8 medical professionals and 6 musician-coaches) who frequently treated MFD sufferers. Throughout their career, these participants are estimated to have interacted with more than 2,000 musicians with MFD, creating a large, indirect sample. A detailed patient profile emerged from the data with three main components: 1) the negative impact of social environments, including traumatic experiences and low quality of instrumental teaching; 2) a perfectionist, anxious, overly sensitive, and acquiescent personality type; and 3) obsessive, controlling, and inadequate practice behaviours. Participants stated MFD needs to be treated holistically and that neglecting these aspects during treatment could jeopardise rehabilitation. Further objective, controlled research trials are needed to describe these factors in detail, quantify their potential impact as risk factors, and understand how they might hinder therapy