Cognitive Ergonomics and the Musician Part I

Many of you have heard of ergonomics and think it only has to do with your desk or chair. But a number of researchers are delving into another area called cognitive ergonomics, the mental processes of playing, in order to understand the mechanism behind injury in musicians. Perception, memory, reasoning, and motor response, all combine to affect mental workload and decision-making while performing. In my first blog on the subject, I gave an overview of what the latest research reveals about Focal Dystonia in musicians. This time I'm taking you down the rabbit hole here, and it must be said, I'm not a researcher. Instead, my hope is that this sparks something in you that helps you recover. Also, in evaluating the efficacy of any treatment, it's important for patients to have as much of the information that's available. Some intermural collaboration among the researchers would be nice as well. Alan H D Watson, professor of music biology at Cardiff University, writes extensively about maladaptive cortical remodeling, what researchers now believe causes Focal Dystonia in musicians. Watson makes some distinctions that my previous blog post did not: namely that men get Focal Dystonia twice as much as women (it's the reverse with repetitive strain injuries or RSIs); and that it typically appears in the late 30s, mid-career, as opposed to RSIs, which tend to appear in the mid-20s for musicians. For these reasons, and because research has not specifically explored the connection between Focal Dystonia and repetitive strain injuries, Watson remains cautious about their connection when other researchers are less so. Watson also notes that instrumentalists get Focal Dystonia about ten times as much as the general population, and that it's most common in pianists and guitarists. Focal Dystonia affects the right hand (70%) much more than the left in pianists, starting with the pinky finger. In guitarists though, it’s the index and middle finger, also of the right hand, that become affected. In violinists, it's mostly the index and ring fingers on the left hand that becomes dystonic. Watson also points out specifically that symptoms tend to come on so gradually, sometimes taking years to develop, and are painless so that sufferers may not initially even notice what's happening. This is so dangerous. One of the ways he describes how you might experience the typical "feeling of heaviness" cited as a symptom is when a finger appears to lag behind others, particularly evident in say a rapid passage that you've played without problem for decades. Brain mapping the sensory-motor neurons in the hand has given us a clearer picture of what's going wrong. Long thought to be a malfunction of motor control outside the brain or spinal chord, researchers now believe Focal Dystonia instead involves the entire central nervous system, including the brain and spinal cord. Brain mapping studies have shown a marked degradation of the receptive fields receiving information from the fingers, causing considerable overlap in how the brain discerns the different fingers, even between the front and back of the hand. These receptive fields get so confused as to literally fuse several finger joints into one in the brain's map of the dystonic hand. In studies involving musicians with Focal Dystonia, finger representations of the dystonic hand can also be much closer together, or in a completely different order. There's even evidence that the non-affected hand of Focal Dystonia patients show this same degradation, although to a lesser degree. This may explain why dystonia sometimes appears quite quickly in the previously non-affected hand when you try to play with your other hand. In order to understand how this sensory-motor mapping gets confused in the brain, we have to look at the mechanics of fine motor learning. We learn movement patterns in stages: fast learning comes in the first few minutes when a new pattern is introduced, followed by a consolidation period for the 6–8 hours after the activity has ended. This is why rest is so important to learning. Subsequent training sessions produce additional improvement, but at progressively smaller increments until you hit a ceiling that's hard to break. Neurons respond to all these signals by making the primary motor cortex larger. And it stays enlarged during subsequent practice sessions, so that new synaptic connections can be made and the motor cortical map reorganized. Dystonia arises then when this motor learning process is not given enough time to go through each stage. Again the rest phase is so important for the brain to make sense of all that input. Are you getting that full 6-8 hours of rest between practice sessions? Between performances? If you're having trouble, you might look there first. @JillGambaro is the author of The Truth About Carpal Tunnel Syndrome. Through her book, website, and healthy musician guidance program, she advocates for patient engagement to help resolve carpal tunnel syndrome and keep musicians playing healthy. Follow Jill on her social channels.