Modified Graded Motor Imagery for Musicians' Focal Dystonia: A Case Series.

Purpose: This study aimed to assess the effectiveness of the "modified graded motor imagery" (mGMI) protocol as a rehabilitative treatment of musician's focal dystonia (MFD).

Methods: Six musicians with MFD (age 43.83±17.24 yrs) performed the home-based mGMI protocol (laterality training, imagined hand movements and visual mirror feedback) once a day for 4 weeks. The mMGI protocol was designed to sequentially activate cortical motor networks and improve cortical organization. Subjects were evaluated before and after treatment with the dystonia evaluation scale (DES), arm dystonia disability scale (ADDS), Tubiana-Chamagne scale (TCS), and performing scale (PS).

Results: All participants were compliant with the mGMI treatment protocol without any adverse events. A significant improvement was measured in ADDS (p=0.047) and TCS scores (p=0.014) but not in DES (p=0.157). The severity of MFD decreased from moderate to mild in four patients. After mGMI treatment, all musicians were able to play easy pieces (TCS: median 3.5, IR 3.5-4).

Conclusion: The findings from this pilot study suggest that home-based mGMI treatment is a feasible and promising rehabilitative approach for patients with mild to moderate MFD.