Sunday, December 8, 2019

Sensory Tricks with Dystonia

 A list of some sensory tricks (i.e. includes motor tricks/forced tricks/reverse tricks/imagery tricks) among various dystonias.

 If you know anyone that has Focal Embouchure Dystonia or thinks they might, the list of Oromandibular Dystonia (jaw dystonia) and Cervical Dystonia (neck dystonia) sensory tricks may give them temporary relief or lessen the overall strength of the symptoms.

 It's also a tell-tail sign you have dystonia if a sensory trick works. However, not all cases report sensory tricks, and some musicians don't even realize it until the neurologist finds they have one during evaluation.

 I come across a lot of brass players with FD where the symptoms and/or tension spreads to their tongue, jaw, neck, shoulders, and upper back. Some of these listed are already common tricks among brass and wind players with ED.

The most that I have come across and been reported to me consistently is: placing something between the teeth, some type of modified guard or splint, icing the face before playing (this worked for me but not the safest), touching the face or neck, drastic change in body movement/posture, focusing on a specific object or visual, change in size or back pressure of mouthpiece, and tongue depressor.

 The key is if you can find a way to incorporate it into rehabilitation or help the sensation of the sensory trick bleed over, it may aid throughout the recovery process. A few examples of this are: "geste" - visualizing the sensory trick, imagery that tricks the brain into avoiding playing mode (ex. I had to visualize blowing on hot cocoa to stop my embouchure from automatically setting). Using a modified guard or splint while playing. Incorporating a tongue depressor throughout retraining to override the damaged brain pathway.

It's not about suppressing the dystonic symptoms or avoiding them. It's about lessening them to a degree so that you have a chance to rebuild a new pathway that the brain recognizes. It's like distracting the messed up signal temporarily so you have a chance to rewire things. Sensory tricks can come in handy if you literally can't get a sound out or things are severe. However, not everyone has a sensory trick.

An actual highly successful method of treatment among musician hand dystonia patients is splinting. And there is only one study that was conducted in Japan on modified dental splinting on three patients with embouchure dystonia with all three returning to performance. It would be great if there was more research in this area of Musician's Dystonia.

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