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Crossing the Bridge: a Descriptive Pilot Study of Sensory Tricks and Related Variables to Musician’S Dystonia Onset Jamie Agee James Madison University

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Crossing the Bridge: a Descriptive Pilot Study of Sensory Tricks and Related Variables to Musician’S Dystonia Onset Jamie Agee James Madison University James Madison University JMU Scholarly Commons Senior Honors Projects, 2010-current Honors College Spring 2017 Crossing the bridge: A descriptive pilot study of sensory tricks and related variables to musician’s dystonia onset Jamie Agee James Madison University Follow this and additional works at: https://commons.lib.jmu.edu/honors201019 Part of the Medicine and Health Sciences Commons Recommended Citation Agee, Jamie, "Crossing the bridge: A descriptive pilot study of sensory tricks and related variables to musician’s dystonia onset" (2017). Senior Honors Projects, 2010-current. 284. https://commons.lib.jmu.edu/honors201019/284 This Thesis is brought to you for free and open access by the Honors College at JMU Scholarly Commons. It has been accepted for inclusion in Senior Honors Projects, 2010-current by an authorized administrator of JMU Scholarly Commons. For more information, please contact [email protected]. Crossing the Bridge: A Descriptive Pilot Study of Sensory Tricks and Related Variables to Musician’s Dystonia Onset ______________________ An Honors College Project Presented to the Faculty of the Undergraduate College of Health Sciences James Madison University _______________________ by Jamie Dawn Agee May 2017 Accepted by the faculty of the Department of Health Sciences, James Madison University, in partial fulfillment of the requirements for the Honors College. FACULTY COMMITTEE: Project Advisor: Katherine Ott-Walter, Ph.D., Reader: Jamie Kurtz, Ph.D., Associate Professor, Health Sciences Associate Professor, Psychology Reader: Derek Strong, Ph.D., Reader: Thomas Hynd, Ph.D., Assistant Professor, Biology Department Lecturer, Biology Reader: Erika Collazo-Vargas, Ph.D., HONORS COLLEGE APPROVAL: Assistant Professor, Health Sciences Bradley R. Newcomer, Ph.D., Reader: Robert Koslow, Ph.D., Dean, Honors College Professor, Health Sciences PUBLIC PRESENTATION This work is accepted for presentation, in part or in full, at JMU Honors Symposium on April 21, 2017. Table of Contents Acknowledgements 4 Abstract 5 Introduction 6 Literature Review 16 Methodology 26 Results 35 Discussion 58 Appendix A 70 Bibliography 83 2 Dedication This Thesis is dedicated to all instrumentalists experiencing the physical and emotional difficulties of musician’s focal dystonia. It is my ardent hope that one day you will not always have to suffer for your art. “If I only had no fingers, and could play with my heart to others!” -- pianist Robert Schumann after dystonia onset 3 Acknowledgements Without God and the loving inspiration of my family who have given me reason to persevere, this thesis could not have been completed. To my advisor and mentor Dr. Katherine Ott-Walter, the guidance and time you have shared with me throughout the duration of this project have been invaluable. Thank you for your support, both mentally and academically, and for imparting in me the knowledge that true growth and accomplishment occur when we can learn to adjust to difficulties which arise and still manage to reach our goals (even if the process/end results are not entirely what we expected). To my mentor and co- advisor, Dr. Derek Strong, you made a dynamic impact in inspiring me to undertake this project, and I thank you for fostering in me an intense fascination for research which has changed the way I view the world. Your continued support, teaching, and guidance have been inestimable, and my time spent learning from you will always be one of my most cherished memories as a JMU student. Thank you for your investment in me. Gratitude should also be expressed to my committee members: Dr. Collazo-Vargas for intensely inspiring me to love research through expression of her own passions and for instilling in me the confidence to begin down that path; Dr. Hynd who taught me the immeasurable lesson that research is not about knowing the answers, but rather the humble pursuit of continued knowledge; Dr. Koslow who exposed me to the exciting world of effort force and torque; and, Dr. Kurtz for her insight and recommendations regarding the psychological measures addressed within this study. Further gratitude is owed to my mentors/friends, physical therapists Dr. Adler and Kristen Wright, who successfully enabled my complete return to violin playing after my own experiences with musician’s focal dystonia. You gave me back my life and influenced my desire to embark on this study. Centennial Scholars Director, Mrs. Strawbridge, you have similarly shaped my way of thinking in inspiring me to persevere beyond struggle to accomplish what I never thought possible. Thank you for the irreplaceable opportunities you have given me. To my dear friends, Jen Lapierre, David O’Rawe, and Max Yamane, who unknowingly motivated me through a time I did not think I could continue, I will always be grateful. Lastly, I would like to recognize the memory of violin instructor Thomas Lindsay who helped me develop my musical voice following dystonia, but passed away during the completion of this project. 4 Abstract Silencing music across the globe, musician’s dystonia, a neurological condition with an unknown etiological basis, has played an integral role in terminating professional musician’s careers. While limited research has been conducted into internal/external factors which may potentially influence musician’s focal dystonia onset, this pilot study sought to identify specific instrumentalists’ behaviors and traits which may exhibit a potential relationship with disease onset and, consequently, the ability to utilize sensory tricks. This specifically included examination of practice approach, auditory/kinesthetic feedback, years played, personality, and approach to practice among the musicians being studied. To assess these characteristics within the dystonic musician population and to determine how this data related to healthy/undiagnosed music students of James Madison University (JMU), a survey instrument created based upon application of the Social Cognitive Theory was distributed. Resulting data analysis indicated fatigue based practice techniques were commonly used among both dystonic musicians and symptomatic JMU students and that maladaptive auditory/kinesthetic feedback mechanisms were positively correlated with negative symptoms. Findings further helped identify which sensory tricks were most commonly employed by dystonic musicians, exposing that instrumental genre may be influential in determining which types are typically chosen to ameliorate negative symptoms. In addition, results which revealed that half of JMU’s music student population currently exhibit dystonic symptoms and unknowingly use sensory tricks generates implications for future research in regards to what preventative changes could be implemented within the educational program. Therefore, the objective of this thesis was to gain not only a comprehensive understanding of potential factors related to musician’s dystonia, but to both expand on previous literature and potentially impact future health outcomes of musicians. 5 Chapter I Introduction Purpose and Significance The exact derivation of musician’s focal dystonia remains largely undetermined, yet current scientific research is not without a plethora of hypothetical theories regarding factors which may play an associated role in manifesting disease onset (Altenmuller & Jabusch, 2009). Characterized by spasmodic and paralytic symptoms localized to body areas which perform musical movement, the disorder is primarily classified as a neurological condition due to somatosensory dysfunction noted on functional MRI (fMRI) (Haslinger, Altenmuller, Castrop, Zimmer, & Dresel, 2010). This classification appears to be further justified by documented cases of the usage of sensory “tricks,” the employment of sensory/tactile stimuli to temporarily alleviate negative neurological symptoms among dystonic musicians (Loyola, Camargos, Maia, & Cardoso, 2012). Though this phenomenon (which may include supporting the affected arm, refingering music, holding a pencil with the affected fingers while playing, etc.) is prevalent throughout previous research findings on musician’s dystonia, a significant deficit of knowledge still exists regarding the exact nature of sensory tricks being employed by musicians (Conti, Pullman, & Frucht, 2008). This lack of information is further intensified by unknown correlations with other variables including age, underlying psychological traits, and repertoire impact on auditory/kinesthetic feedback. Therefore, the intention of this research study was to both identify existing sensory tricks being utilized across the affected population and examine how the dystonic symptoms they were intended to help ameliorate were impacted by personality traits, age, and auditory/kinesthetic feedback abilities. 6 This study further aimed to determine whether sensory tricks would/would not be useful by all dystonic musicians of a particular instrumental genre and whether potential correlative factors may impact their effectiveness. Research into this aspect sought to address the idea present within past literature concerning generalized non-musician’s dystonia which upholds the idea that the effectiveness of specific sensory tricks is specific to the affected individual and not effective if shared with other dystonic patients (Ramos, Karp, & Hallet, 2014). Thus, the present study also sought to determine whether sensory trick usage was similar between musicians of comparable instrumental genres due to the specificity of musically related movement types. Examining
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