Focal Hand Dystonia: Effectiveness of a Home Program of Fitness and Learning-based Sensorimotor and Memory Training

Study Design: This was a pre post test design. Introduction: Retraining the brain is one approach to remediate movement dysfunction resulting from task specific focal hand dystonia (FHDTSP). Purpose: Document change in task specific performance (TSP) for patients with FHDTSP after 8 weeks of comprehensive home training (fitness activities, task practice, learning based memory and sensorimotor training). Methods: Thirteen subjects were admitted and evaluated at baseline, immediately and 6 months post treatment for task specific performance, functional independence, sensory discrimination, fine motor speed and strength. In Phase 1, 10 subjects were randomly assigned to home training alone or supervised practice prior to initiating the home training. In phase II, 2 subjects crossed over and 3 new subjects were added (18 hands). The intent to treat model was followed. Outcomes were summarized by median, effect size, and proportion improving with nonparametric analysis for significance. Results: Immediately post-intervention, TSP, sensory discrimination, and fine motor speed improved 60-80% (p<0.001 respectively). Functional independence and strength improved by 50%. Eleven subjects (16 hands) were re-evaluated at 6 months; all but one subject reported a return to work. Task-specific performance was scored 84-90%, Supervised practice was associated with greater compliance and greater gains in performance. Conclusions: Progressive task practice plus learning based memory and sensorimotor training can improve TSP in patients with FHDTSP Compliance with home training is enhanced when initiated with supervised practice. Level of Evidence: 4. J HAND THER. 2009;22:183-98.