Načini zdravljenja žariščne distonije prstov roke pri glasbenikih – pregled literature : diplomsko delo

Bras, Eva (author), Rugelj, Darja (mentor), Hlebš, Sonja (reviewer)

Uvod: Žariščna distonija roke prizadene 1% profesionalnih glasbenikov, pogosteje so prizadeti moški. Dejavniki tveganja so genetski, biomehanski ter povezani s ponavljajočimi, natančnimi in hitrimi gibi roke. Gre za pojav prekomernega vzpodbujanja možganske plastičnosti, kar povzroči povečanje motoričnega področja roke. Tam pride do večjega proprioceptivnega priliva in zmanjšane inhibicije, kar se lahko razširi tudi v sosednja področja. Pojavijo se motnje v mišični koordinaciji ali odsotnost zavestnih gibov takoj, ko oseba prične z igranjem inštrumenta. Del telesa, na katerem pride do distonije, je odvisen od vrste inštrumenta ter dominantne roke. Zdravljenje zajema intervencije, ki vplivajo na možgansko plastičnost, zdravila in operacijo. K nastanku distonije dlani in prstov so najbolj nagnjeni pihalci, godalci, brenkalci in glasbeniki, ki igrajo na glasbila s tipkami. Namen: Namen diplomske naloge je na podlagi pregleda literature analizirati načine zdravljenja glasbenikov z žariščno distonijo prstov roke. Metode dela: Uporabili smo opisno metodo dela s pregledom literature. Članke smo iskali na podatkovni bazi PubMed, pri dobljenih člankih pa smo uporabili metodo snežne kepe za nadaljnjo iskanje primerne literature. Rezultati: V pregled smo vključili sedem raziskav objavljenih med letom 2002 in 2014 ter ocenili njihovo kakovost po PEDro lestvici. V pregled smo zajeli 257 glasbenikov ter šest zdravih posameznikov (1 raziskava). Najbolj zastopan inštrument je bil klavir (5 raziskav). Pri merjenju napredka so najpogosteje uporabljali metronom (5 raziskav), vprašalnik (2 raziskavi) ter lestvice za oceno stopnje distonije (4 raziskave). Uporabljene intervencije so bile z omejevanjem spodbujajoča terapija (4 raziskave), kombinacija izvajanja zrcalnih gibov ter vmesnega proženja različnih vrst impulzov transkranialne stimulacije z direktnim električnim tokom (1 raziskava) ter vibracija mišice. Zmanjšanje simptomov je bilo prisotno pri vseh intervencijah, večje izboljšanje pa so dosegli glasbeniki, ki za igranje inštrumenta ne potrebujejo vanj pihati. Pri vibraciji mišice je prišlo do izboljšanja tako pri bolnih kot tudi pri zdravih glasbenikih (1 raziskava). Razprava in zaključek: Intervencije, ki vplivajo na možgansko plastičnost so učinkovite vendar moramo biti pozorni, da postopoma večamo težavnost in trajanje vadbe. Dobljene raziskave imajo majhne in heterogene vzorce, zato rezultate težko posplošimo na celotno populacijo glasbenikov. Potrebne so raziskave z večjimi in homogenimi vzorci, kontrolno skupino ter jasnejšimi izidi.

• Language: Slovenian
• Keywords: diplomska dela, fizioterapija, glasbeniki, distonija, roka, možganska plastičnost, ponovno učenje
• Work type: Bachelor thesis/paper
• Typology: 2.11 - Undergraduate Thesis
• Organization: ZF - Faculty of Health Sciences
• Place of publishing: Ljubljana
• Publisher: [E. Bras]
• Year: 2020
• Number of pages: 32 str., [3] str. pril.
• PID: 20.500.12556/RUL-116805
• UDC: 615.8
• COBISS.SI-ID: 20415235
• Publication date in RUL: 11.06.2020

BRAS, Eva, 2020, Načini zdravljenja žariščne distonije prstov roke pri glasbenikih – pregled literature : diplomsko delo [online]. Bachelor’s thesis. Ljubljana : E. Bras. [Accessed 10 June 2025]. Retrieved from: https://repozitorij.uni-lj.si/IzpisGradiva.php?lang=eng&id=116805

Secondary language

• Language: English
• Title: Treatment options for musician's cramp – literature review : diploma work

Abstract

Introduction: Focal hand dystonia affects 1% of professional musicians. Men are more affected. Risk factors are genetic, biomechanical and relative to repeated, precise and fast movements of the hand. The reason for that is too much brain plasticity which causes enlargement of the motor receptive field of the hand. There, it causes increased proprioceptive input and decrease of inhibition which can also spread to the neighboring receptive fields. It causes disorders in muscle coordination and involuntary movements shortly after the person starts to play the instrument. The location depends on the instrument and hand dominance. It is important to take thorough anamnesis about the hand injuries and burden. Treatment involves interventions that have an impact on brain plasticity, medication, and operation. Winds, strings, plugged and keyboard musicians have the most tendency to develop focal hand dystonia. Purpose: The purpose of this diploma work was to review research about the treatment options for focal hand dystonia of musicians. Methods: A descriptive method was used. First, studies in the PubMed database were searched for, then the snowball method was used to get more studies. Results: Seven articles, published between 2002 and 2014 were included and their quality was evaluated with the PEDro scale. 257 musicians – 18 were healthy (2 studies) and 6 healthy subjects (1 study) were captured in our review. The piano was the most common instrument (5 studies). By measuring the progress metronome (5 studies), questioner (2 studies) and scales for measuring the stage of dystonia (4 studies) were most commonly used. Used interventions were constraint-induced therapy (4 studies), a combination of mirrored finger movements while having different impulses with transcranial direct current stimulation (1 study) and muscle vibration. Improvement was seen in all of the above-mentioned interventions, better results were seen in musicians, who don't require too blow in their instrument. Muscle vibration has also shown improvement for healthy musicians. Discussion and conclusion: Interventions that influence brain plasticity are effective but they have to be carefully enhanced in difficulty and practice duration. The studies considered have small and heterogenic samples, so the results are difficult to generalize on the whole musicians' population. Studies with larger and homogenous samples, control group and clearer results are needed.

• Keywords: diploma theses, physiotherapy, musicians, dystonia, hand, brain plasticity, retraining