Focal Dystonia and Retraining the Hand

Ergonomics and Posture for Classical Guitarists, Aches and Pains, Injuries, etc...
guit-box
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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Sat Jun 23, 2018 4:00 am

I become more convinced every day as my playing continues to get better that the trigger for my right hand dystonia in my index and middle fingers was from trying to push through the string with the large knuckle joint and focusing on the main effort coming from the large knuckle joint (metacarpal phalangeal joint MCP). I've studied close up videos of the right hands of all the greatest classical guitarists and what I see is a focused effort coming from the two smaller joints while the large knuckle joint (MCP) actual extends away from the hand. When I do the opposite of what I was taught to do and instead focus the pluck as a flexion from the middle joint (pip) and tip joint (dip) while extending the MCP, my hand feels more relaxed and natural and I can play better. If the old way drifts back into my playing, the tension and heavy effort-filled feeling returns.

Check out Johannes Moller plucking exactly the above way.



An eyewitness will often only see what he already believes to be true.

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Patona
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Re: Focal Dystonia and Retraining the Hand

Post by Patona » Sat Jun 23, 2018 10:35 am

Many thanks to guit-box for your tireless efforts to find the right stroke. Your threads on this topic helped me a lot. The problem with FD for me is that I lack the complete process of moving the right hand on the guitar. When I mean I found a right process to do the process of stroke at the one day, I can not repeat that next day.

Also, I do not get a proper rest in the hand when I'm sitting at the instrument The analysis of guit-box helped a lot to break the stroke into its individual components. I now practice every single component separately.
1) The knuckle brings the finger to the string. Not more. The hit area is between flesh and nail.
2) Then the middle joint starts his work. I keep the DIP relatively stiff. With a kind of scratching motion I move my finger over the flesh and the nail, while the knuckle does not move or moves very little
3) Short stroke without effort.
After that the stroke is over and I bring the finger back to the original position, or I stay in the stroke position and wait for another finger, like an arpeggio. Who reminds this to the description of Phillip Hii, I agree.

What I do not, or can not do at this time is the flexible DIP. In the attempt to pluck so, the dystonic reflex appears immediately. Maybe I'll do that later. The full relaxation of the hand I get only when the guitar is flat on my knees, like a hawaii guitar. I support the forearm and wrist with a rolled-up towel, which I lay lengthwise on the top and put my arm on it. I know that this is not the way to playing guitar, but it is the first time in over two years that my hand feels relaxed and i can pluck without dystonic effects. I have the hope that there will be such neuroplastic changes and that I can set up the guitar again.

Thanks once again to guit-box, that I found a course of movement through his help.

Look also to this topic of Ortega:
viewtopic.php?f=6&t=120108&p=1286552#p1286552
"Don’t try to calm the ocean. Learn to swim between the waves."

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guit-box
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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Sat Jun 23, 2018 5:29 pm

Thanks, Patona, I'm glad my efforts are helping you too. I make no claims that I have any cure for focal dystonia, but I know two things for sure:

1. Dystonia or not, it takes 1000s of hours of practice to play classical guitar well, so you better make sure the movements are correct. The purpose of the video analysis is to find out if there are commonalities in the way the best players move their right hands.

2. There are contradictions between what is commonly taught in lessons, method books, videos and what those same teachers are doing when they perform. Obviously it works for some, but for the few who take this advice and try to apply it by following it too closely and not let their finger joints move as they naturally want to (contrary joint movement), it can be a disaster.

I think Ortega makes some valid points, but I'm not convinced by the concept of "passive movement" which he describes a lot. It's also impossible for the tip joint to be the only thing that plucks when we can clearly see other joints moving even more than the tip joint does. I believe that if you see a finger segment moving, then it is actively moving. We can see in most player's hands that the MCP (large knuckle joint) is moving that segment away from the hand at the moment the two smaller joints flexion into the palm. As a practice technique, I've found that in order to cement this new movement in my brain, I need to do massive amounts of DIP/PIP (middle and tip) joint flexion while simultaneously doing MCP (large knuckle) joint extension. Flexion ALL the way, and extension ALL the way, and do this slowly and deliberately as a warm-up. Then, of course, you back off on that for actual playing, but I find this exaggeration is helpful in developing the muscular strength and coordination of this new movement which is much different than focusing on the movement coming mainly from the MCP and the other joints are just helpers, it's actually the very opposite of that.
An eyewitness will often only see what he already believes to be true.

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Re: Focal Dystonia and Retraining the Hand

Post by Dofpic » Sat Jun 23, 2018 8:00 pm

There is a study in Japan where they did brain surgery by way of Focused ultrasound (a brain ablation) on 15 guitarist and 14 were cured immediately and so far with post surgery times of 4-30 months no recurrence of dystonia. The only blade they used was the one to shave their heads! It is now approved by FDA to treat Essential Tremors at U of VA and Maryland with miraculous results.

www.fusfoundation.org
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Re: Focal Dystonia and Retraining the Hand

Post by guit-box » Sun Jun 24, 2018 3:30 pm

The focused ultrasound study sounds interesting. I shortly looked at the website and couldn't find any page that claimed they cured 14 out of 15 guitarist. If there is such a page on that site, please post a direct link to it. I'm interested in hearing more, but am also skeptical that any treatment can instantly reverse focal dystonia symptoms that returns a guitarist to their playing level before they got dystonia. Of course it could be possible, but my experience with treatments is all negative. The focal dystonia researchers I worked with who did 3 rounds of Repetitive Transcranial Magnetagnetic Stimulation (rTMS) on me all said these kinds of treatments were experimental, and only showing minimal positive affects. But that was a couple years ago, and medical technology makes fast advancements. I'll be interested to hear more specifics.
An eyewitness will often only see what he already believes to be true.

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Re: Focal Dystonia and Retraining the Hand

Post by Dofpic » Sun Jun 24, 2018 6:30 pm

There was a posting on May 24th from Ramon titled Ultrasound for focal dystonia. The dr in the article is the one that has done the procedure. Just goes to prove by doing the brain ablation it is neurological. We get it by becoming obsessive and over practicing certain techniques. They are doing amazing things for essential tremors at university of Virginia. google focused ultrasound for essential tremors and you will find some amazing stuff. I will stick with working on it the natural way until they have done at least 100 patients and have more reliable data to go on.
2006 Greg Byers(fan)2009 Eric Monrad(maple) 2018 Simon Ambridge Model 40 Satinwood. 2003 Tacchi Simplcio satinwood 2017 E. Bottelli 52 Hauser, 2002 Jeff Elliott spruce, 2017 Richard Reynoso, spruce/maple, 2015 Herman Hauser III(Cedar)2005 Tacchi Coclea

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Re: Focal Dystonia and Retraining the Hand

Post by Dofpic » Sun Jun 24, 2018 6:54 pm

2006 Greg Byers(fan)2009 Eric Monrad(maple) 2018 Simon Ambridge Model 40 Satinwood. 2003 Tacchi Simplcio satinwood 2017 E. Bottelli 52 Hauser, 2002 Jeff Elliott spruce, 2017 Richard Reynoso, spruce/maple, 2015 Herman Hauser III(Cedar)2005 Tacchi Coclea

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Patona
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Re: Focal Dystonia and Retraining the Hand

Post by Patona » Mon Jun 25, 2018 9:52 am

I have wrote to Prof. Taira in Japan and asked him for preliminary results of his study. Maybe he answers.
"Don’t try to calm the ocean. Learn to swim between the waves."

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Ramirez 1a, 1972, cedar

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Patona
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Re: Focal Dystonia and Retraining the Hand

Post by Patona » Tue Jun 26, 2018 8:58 am

Here is the answer of Prof. Taira:

----We have been treating musician's cramp (dystonia) with neurosurgical operation for nearly 20 years. Several hundred patients with focal hand dystonia underwent surgery called Vo thalamotomy with long-term successful results.

Therefore, use of focused ultrasound is natural movements towards less invasiveness.
So far, we finished 10-cases feasibility study with promising results. The first case report was accepted for publication in Journal of Neurosurgery, and the manuscript is attached.

Considering the difficulty of conservative treatment of focal hand dystonia, and the fact that most musicians are not satisfied with Botox injections or transcranial magnetic stimulation, I do consider that Vo thalamotomy is the only method to cure musician's dystonia.

We also started treatment of embouchure dystonia (see the attached)
.......

If anyone is interested of the pdf`s please PM me.
"Don’t try to calm the ocean. Learn to swim between the waves."

Boguslav Teryks Doubletop. spruce-cedar
Hanika 1A/PF, spruce
Ramirez 1a, 1972, cedar

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Re: Focal Dystonia and Retraining the Hand

Post by Dofpic » Tue Jun 26, 2018 12:58 pm

Terrific Job Patona! I will PM shortly
2006 Greg Byers(fan)2009 Eric Monrad(maple) 2018 Simon Ambridge Model 40 Satinwood. 2003 Tacchi Simplcio satinwood 2017 E. Bottelli 52 Hauser, 2002 Jeff Elliott spruce, 2017 Richard Reynoso, spruce/maple, 2015 Herman Hauser III(Cedar)2005 Tacchi Coclea

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Re: Focal Dystonia and Retraining the Hand

Post by Dofpic » Wed Jun 27, 2018 3:09 am

I read the articles from Patona and this is amazing stuff. Just goes to show it is in the brain not the hand!
2006 Greg Byers(fan)2009 Eric Monrad(maple) 2018 Simon Ambridge Model 40 Satinwood. 2003 Tacchi Simplcio satinwood 2017 E. Bottelli 52 Hauser, 2002 Jeff Elliott spruce, 2017 Richard Reynoso, spruce/maple, 2015 Herman Hauser III(Cedar)2005 Tacchi Coclea

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Re: Focal Dystonia and Retraining the Hand

Post by Patona » Wed Jun 27, 2018 6:52 am

After I have worked through both types of treatment methods and have also asked my doctors of the musician ambulance, I come to the following resumee for me personally:

Both treatment methods (Vo-Thalamotomy and focused Ultrasound) are massive interventions in the brain structure. Vo Thalamotomy is an invase method, which means that thermoprobes are introduced into the brain and the sick areas are attacked.
Focused Ultrasound is non-invasive but has the same effect. Both merthodes are not reversible.

I do not think that I would make such changes to me with uncertain long-term effect. I will continue to work for myself with the retuning and retraining method. The successes with this method are described more and more. Although it is uncertain how long it will take for each individual, but I keep all parts of my brain.
"Don’t try to calm the ocean. Learn to swim between the waves."

Boguslav Teryks Doubletop. spruce-cedar
Hanika 1A/PF, spruce
Ramirez 1a, 1972, cedar

Dofpic
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Re: Focal Dystonia and Retraining the Hand

Post by Dofpic » Wed Jun 27, 2018 1:25 pm

My opinion is after they have done several hundred successful FUS Operations I might consider it but for now I just came back from Spain and did a redo of my initial treatment and feel very good about my prospects for recovery so will go that way. 9-24 Months from now I will hopefully realize my dream of overcoming this awful condition.
2006 Greg Byers(fan)2009 Eric Monrad(maple) 2018 Simon Ambridge Model 40 Satinwood. 2003 Tacchi Simplcio satinwood 2017 E. Bottelli 52 Hauser, 2002 Jeff Elliott spruce, 2017 Richard Reynoso, spruce/maple, 2015 Herman Hauser III(Cedar)2005 Tacchi Coclea

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