In 1964 Leon Fleisher, one of the leading concert pianists of the time, lost the use of his right hand.  Forty years later he was once again performing with both hands.  His friend, Gary Graffman – also an artist of international stature – was similarly afflicted in 1979 (http://www.nytimes.com/1981/06/14/arts/when-a-pianist-s-fingers-fail-to-obey.html?pagewanted=all).  Other high-profile pianists affected by this condition called focal dystonia include Glenn Gould, Michel Beroff and, more recently, Jean-Efflam Bavouzet.

According to Wikipedia, “Focal dystonia is a neurological condition that affects a muscle or group of muscles in a part of the body and causes an involuntary muscular contraction or twisting. “  It is generally painless and task-specific, meaning that it is a problem that only affects the kind of specific, intricate movements involved in activities such as playing a musical  instrument.  However, Writer’s Cramp is a form of dystonia.  The cartoonist Scott Adams, creator of the Dilbert comic strip, suffers from this condition and has to use a graphics tablet for drawing.

“The misfiring of neurons in the sensorimotor cortex, a thin layer of neural tissue covering the brain is thought to cause contractions. The sensorimotor cortex contains “maps” of the human body. Under normal conditions, discrete body parts (such as the individual fingers) occupy their own distinct areas on these sensorimotor cortex maps. However, in dystonia these maps cease to be distinct.

Research showing this initially involved non-human primates that were over-trained on particular finger movements with the result that they developed focal hand dystonia. Examination of their primary somatosensory cortex showed that the representations of the fingers were grossly distorted with finger representations that were segregated in normal animals having become co-represented in the cortex of dystonic animals. Imaging studies on humans have confirmed this finding with individuals with focal hand dystonia having finger representations in their brains that are abnormal in showing fusion compared to those in normals.

The cross-connectivity between areas that are normally segregated in sensory cortex may prevent normal sensorimotor feedback and so contribute to co-contractions of antagonist muscle groups, and inappropriately timed and sequenced movements that underlie the symptoms of focal dystonia of the hand.

Prior to the work that demonstrated sensorimotor cortical deficits, focal hand dystonia was principally treated with BoTox injections, which block muscle contractions in affected muscles. Following that work, multiple groups have demonstrated that behavioral remediation can ameliorate many symptoms, and restore most of the performance deficit.

While usually painless, in some instances the condition causes pain—usually through sustained contraction and abnormal posturing. Focal dystonia most typically affects those who rely on fine motor skills—musicians, writers, surgeons, etc. It is generally “task specific,” meaning that it is only problematic during certain activities.” (Wikipedia)

Focal dystonia can be triggered by practising through an acquired trauma or injury, such as a sprained muscle in the case of Gary Graffman.  Genetic susceptibility probably plays a part, given that only a very low percentage of performing artists acquire this disability.  In my case, I am convinced it was during a particularly intense period of “catching up” before and during music college that was to blame.

It was around 1982 that I really had the compulsion to play the piano.  Up until then it was simply an ability without direction and something I was rather embarrassed about, as a teenager in the Seventies.  It had been six or seven years since my last piano lesson and in any case the training I had received was relaxed and unstructured in the extreme!  So here I was, 19 years old and driven with new passion for Chopin and the recordings of Maurizio Pollini and Martha Argerich.  When I was reluctantly admitted onto the A Level Music course I was advised that I stood virtually no chance of even getting my Grade VIII, let alone getting to music college.  The following year I passed my Grade VIII with Distinction and a year later was admitted with an unconditional offer to Birmingham School of Music (now Birmingham Conservatoire).

Without (I hope) an inflated view of my own potential or work ethic, I can say with all honesty that in all my time spent at various colleges I have not met anyone more driven and dedicated to practice than I was during those years.  I was desperate to overcome basic difficulties that others didn’t seem to have.  In some respects I could play things that most people couldn’t, possessed a good memory and a high degree of musicality, but could not play a simple Alberti bass or chromatic scale.  Chopin and Brahms for me were much easier than Haydn or Mozart!  I was very conscious of hiding behind complexities, paranoid about exposing my basic technical inadequacies:  I played the Berg sonata from memory in the hope that no one would notice that I couldn’t play a scale.

To some extent I was relieved to get away from college in 1987, although I had left with no qualification.  I felt more able to work on my technique at home, which is basically what I did for the next ten years.  Of course I had to do other things, earn money, etc.  But I never lost the need to persevere.  Sometimes I would appear to have a major breakthrough, as though a door would partially open so that I could glimpse briefly just how good it could be.  Although these moments would be short-lived, they occurred with sufficient regularity to give me renewed hope and confidence.  Occasionally they still happen now.

When I eventually got onto the Internet around 2001, I read a dissertation by Jonas Sen called “Playing the Piano: Playing with Fire?”   where I discovered the facts about Leon Fleisher and others.  Thanks to this I was able to make contact with Carola Grindea in London.  She showed me a different, more holistic approach to piano technique.  With her help I progressed sufficiently to pass my Recital Diploma.  Subsequently I was officially diagnosed with Focal Hand Dystonia and I am currently undergoing treatment with Katherine Butler at London Hand Therapy.

I have opened this blog with the intention of recording my progress in coping with – and hopefully overcoming – what is, in purely pianistic terms, a serious disability.

Read more…