Journal Article Review, November 2019

The Effect of Kinesotaping Fingers for Musicians with Dystonia

Bravi, R et al: Assessment of the effects of Kinesiotaping on musical motor performance in musicians suffering from focal hand dystonia: a pilot study. Clin Rehabil. 2019 Oct;33(10):1636-1648.

Investigators from Italy and Germany recently studied seven highly experienced (years playing 26 +/-10) male musicians (age 36 +/- 9) who had focal hand dystonia for an average of 9 +/- 10 years beginning at age 27 +/- 3 years.  Four participants played keyboard instruments, and the others played either the violin, guitar, or clarinet.

Each musician, blinded to the purpose of the study, warmed up and then performed a proscribed musical exercise before and after Kinesiotaping with Correctional Kinesiotaping (CK) and Sham Kinesiotaping (SK). Neither the experts who evaluated the performances nor the musicians knew whether the fingers had been taped for CK or SK. The musicians also self-reported their impressions after CK and SK, which were randomly applied. During the experiment the investigators also measured the electromyographic activity of the wrist antagonist muscles.

A neurologist specializing in movement disorders made the diagnosis of focal hand dystonia, defined as a painless loss of fine digital motor coordination occurring while playing a musical instrument. Loss of coordination consisted of the involuntary flexion of one or more fingers (dystonic fingers) or uncontrolled extension of adjacent digits (compensatory fingers).

Four professional musicians, two of whom were also health-care-professional experts in movement disorders, evaluated the subjects’ performances with a standardized video rating procedure. The videoclips were randomized and paired, and the raters compared pairs according to “general performance” and “finger posture” and ranked them on a visual analog scale ranging from “strongly resembling natural posture” to “strongly deviating from natural posture.”

Correctional Kinesiotaping was customized to each musician according to his specific dystonic pattern, either by normalizing uncontrolled flexion with application of the tape to the dorsum of the finger or by normalizing uncontrolled extension of a compensatory finger by applying tape to its volar surface.

Sham Kinesiotaping was performed on the same fingers to which the CK had been applied (or would be applied, according to the randomization). The same length of tape was applied, but it was split and applied medially and laterally and without stretching.

With video and EMG monitoring, each musician played a baseline exercise, had CK and SK in random order followed by playing the same passage, and then played again immediately after tape removal.

RESULTS: The experts noted no significant differences for either finger posture or general performance between CK and SK. Subtle differences noted during CK were lost after tape removal. The musicians felt that CK did not improve their performance, and the EMGs did not show any differences in coactivation of wrist flexors and extensors.

DISCUSSION: This was a pilot study; and with the negative results, the investigators noted that they were not planning to pursue this treatment possibility further. They acknowledge that the study group was small and heterogeneous regarding the musical instrument and the finger(s) involved and that there was no control group of unaffected musicians.

COMMENT: The investigators rigorously applied a creative and simple method to study a vexing problem. Their inventiveness, careful methodology, and willingness to publish negative results deserve emulation.