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The Journal of Neuroscience, November 18, 2009, 29(46):14627-14636; doi:10.1523/JNEUROSCI.2094-09.2009

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Behavioral/Systems/Cognitive
Regaining Motor Control in Musician's Dystonia by Restoring Sensorimotor Organization

Karin Rosenkranz,^1,2 Katherine Butler,³ Aaron Williamon,⁴ and John C. Rothwell¹

¹Sobell Department of Motor Neuroscience and Movement Disorders and ²Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, London W1N 3BG, United Kingdom, ³London Hand Therapy, London W1H 5TF, United Kingdom, and ⁴Royal College of Music, London SW7 2BS, United Kingdom

Correspondence should be addressed to Dr. Karin Rosenkranz, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, 33 Queen Square, London W1N 3BG, UK. Email: k.rosenkranz{at}ion.ucl.ac.uk

Professional musicians are an excellent model of long-term motor learning effects on structure and function of the sensorimotor system. However, intensive motor skill training has been associated with task-specific deficiency in hand motor control, which has a higher prevalence among musicians (musician's dystonia) than in the general population. Using a transcranial magnetic stimulation paradigm, we previously found an expanded spatial integration of proprioceptive input into the hand motor cortex [sensorimotor organization (SMO)] in healthy musicians. In musician's dystonia, however, this expansion was even larger. Whereas motor skills of musicians are likely to be supported by a spatially expanded SMO, we hypothesized that in musician's dystonia this might have developed too far and now disrupts rather than assists task-specific motor control. If so, motor control should be regained by reversing the excessive reorganization in musician's dystonia. Here, we test this hypothesis and show that a 15 min intervention with proprioceptive input (proprioceptive training) restored SMO in pianists with musician's dystonia to the pattern seen in healthy pianists. Crucially, task-specific motor control improved significantly and objectively as measured with a MIDI (musical instrument digital interface) piano, and the amount of behavioral improvement was significantly correlated to the degree of sensorimotor reorganization. In healthy pianists and nonmusicians, the SMO and motor performance remained essentially unchanged. These findings suggest that the differentiation of SMO in the hand motor cortex and the degree of motor control of intensively practiced tasks are significantly linked and finely balanced. Proprioceptive training restored this balance in musician's dystonia to the behaviorally beneficial level of healthy musicians.

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Received May 4, 2009; revised Sept. 21, 2009; accepted Sept. 24, 2009.

Correspondence should be addressed to Dr. Karin Rosenkranz, Department of Clinical and Experimental Epilepsy, UCL Institute of Neurology, 33 Queen Square, London W1N 3BG, UK. Email: k.rosenkranz{at}ion.ucl.ac.uk

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