Distonia

J. Anat. (2006) 208, pp527–542

Blackwell Publishing Ltd

REVIEW

What can studying musicians tell us about motor control of the hand?
Alan H. D. Watson
School of Biosciences, Cardiff University, UK

Abstract
Most standard accounts of human anatomy and physiology are designed to meet the requirements of medical education and therefore consider their subject matter from the standpointof typical rather than outstanding levels of performance. To understand how high levels of skill are developed and maintained, it is necessary to study elite groups such as professional athletes or musicians. This can lead to the rediscovery of arcane knowledge that has fallen into neglect through a lack of appreciation of its significance. For example, although variability in the muscles andtendons of the hand was well known in the nineteenth and early twentieth centuries, it is through recent studies of musicians that its practical significance has become better appreciated. From even a cursory acquaintance with the training methods of sportsmen and women, dancers and musicians, it is clear that sophisticated motor skills are developed only at the cost of a great deal of time and effort.Over a lifetime of performance, musicians arguably spend more time in skill acquisition than almost any other group and offer a number of unique advantages for the study of motor control. Such intensive training not only modifies cortical maps but may even affect the gross morphology of the central nervous system. There is also evidence that in certain individuals this process can becomemaladaptive. Recent studies of musicians suggest that intensive training can lead to the appearance of ambiguities in the cortical somatosensory representation of the hand that may be associated with the development of focal dystonia; a condition to which musicians are particularly prone. The realization that changes in cortical maps may underlie dystonia has led to the development of new approaches toits treatment, which may ultimately benefit musicians and non-musicians alike. Key words focal dystonia; motor cortex; motor learning; skeletal muscle; tendon.

Introduction
Over the last few decades, a growing interest in the biology of sporting performance in elite athletes has stimulated new research into whole body physiology, tissue structure and gross anatomy that has led to significantadvances both in training and in the effective treatment of injury. Although it has made less impact in the field of neuroscience, recent research on another elite group, instrumental musicians, suggests that it may provide considerable insights into motor control and higher sensory processing. The degree of motor

Correspondence Dr Alan H. D. Watson, School of Biosciences, Cardiff University,Museum Avenue, Cardiff CF10 3US, UK. E: watsona@cardiff.ac.uk Accepted for publication 16 January 2006

control demanded of musicians makes them excellent subjects for the study of skill acquisition and the exploration of the limits of performance. Indeed as a group they present some unique advantages in this respect. Many begin their training at a very early age, often before the age of 7 years,when the circuitry of the central nervous system is still very plastic. To perform at the highest level, their motor skills must be honed by many hours of daily practice, but as the activity involved is not energetically demanding, physical fatigue is not generally a limiting factor. As a consequence, intensive training can be maintained over almost the entire lifespan. Practice sessions are almostentirely devoted to skill acquisition and are not diluted by the extensive periods of strength conditioning typical of athletic training. In keyboard and string players, motor activity is focused primarily on the muscles which control the

© 2006 The Author Journal compilation © 2006 Anatomical Society of Great Britain and Ireland

528 Hand motor control, A. H. D. Watson

hand. The object...