Lübeck Academy of Music

Background:Musician’s dystonia (MD) is a task-specific movement disorder affecting up to 1% of all professional musicians. Although adverse childhood experiences (ACEs) have been proposed as risk factors, the etiology of MD is not fully understood, and protective factors remain largely unexplored.Objective:This study investigated a possible protective role of psychological resilience on the association between MD and adverse childhood experiences and examined the influence of dystonia, resilience and ACEs on the stress reactivity of musicians.Methods:Forty participants with MD were compared to 39 matched healthy musicians. While undergoing the “Montreal Imaging Stress Task”, cortisol responses of the participants were measured. Furthermore, participants completed two psychological assessments, the Connor-Davidson Resilience Scale and the Childhood Trauma Questionnaire. Mediation and moderation analyses evaluated the mitigating role of resilience on the relationship between ACEs and MD. Bayesian multilevel models were used to analyze links between cortisol responses, ACEs and MD.Results:Healthy musicians showed higher resilience than MD patients, especially when looking at the dimensions “adaptability/flexibility” (W = 517, p = 0.004) and “regulation of emotion and cognition” (W = 554, p = 0.011). Resilience moderated the association between ACEs and dystonia (–0.29 [–0.47, –0.10]). MD patients and healthy participants did not differ in their cortisol output.Discussion:While links between acute stress reactivity, ACEs and MD were more equivocal, resilience seems to decrease the negative effects of ACEs on MD development.The results of this study emphasize the need to implement resilience enhancing interventions at an early state of musical education.HighlightsMusicians suffering from musician’s dystonia (MD) and healthy musicians were compared concerning resilience, adverse childhood experiences (ACEs) and their stress reactivity.Healthy musicians showed tendencies of higher resilience than MD patients.Resilience appears to decrease the negative effects of ACEs on the development of musician’s dystonia.MD patients and healthy musicians did not display differences in their cortisol output when presented with an acute stress task.

Musician's dystonia is often described as a neurological disorder, resulting from reduced inhibition in the basal ganglia and the cerebellum and dysfunctional cortical plasticity. However, several studies over the last decades support the hypothesis that psychological factors play an important role in the aetiology of dystonia, contradicting its classification as "purely neurological". Especially adverse childhood experiences (ACEs) such as neglect, maltreatment, or household dysfunction may influence the sensorimotor system, additionally to the impact they have on psychological traits. They are known to alter limbic networks, such as the amygdala, the hippocampus, and the stress response via the hypothalamus-pituitary-adrenal (HPA) axis and might also affect the cortico-striatal-thalamo-cortical loop that is vital for correct motor movement learning. Especially a higher activity of the basolateral amygdala could be important by increasing the consolidation of dysfunctional motor memories in stressful situations.Therefore, this chapter explores how musician's dystonia might be a result of dysfunctional stress-coping mechanisms, additionally to the already established neurological alterations.

When looking for the possible cause of distortions in values measured for the determination of breath ethanol concentration (BEC) in artificially respirated patients, consideration must be given to the humidity and temperature of the gas examined. In the present study, the effects of humidified and warmed and of dry and cold air on the accuracy of a newly developed BEC measuring device, as compared to a reference model and to a conventional system, were examined in a lung model. A temperature-regulated pediatric incubator was used containing a 10 I gas reservoir and a breath humidifier with temperature regulated water bath. This setup provided constant temperature and humidity in the gas examined during measurement period. In the 'expiration' the air was directed from the breath humidifier through a measuring unit via a 'mouthpiece' into the reference system (Alcotest 7110, Dräger Inc., Lübeck) and then out. The measuring unit consisted of sensors for the temperature and relative humidity, and of a connector for the three sample extraction systems (PES). PES I was the conventional system with a 100-cm gas-sample pipe (Alcomed 3010), PES II the newly developed system (AlcoMed 3011, both from Envitec, Wismar) with a 10-cm gas-sample pipe, and PES III with a 20-cm heated gas-sample pipe. During 'inspiration' 2 l of air was fed into the system to rinse the measuring unit and to fill the reservoir. 61 measurements were performed with dry and cold air, and 71 with humidified and warmed air, in the course of which the ethanol concentration was increased from 0 to 1.5/1000. Data were evaluated using regression analysis and the Bland & Altman method. The constancy of the values set for temperature, relative humidity and absolute humidity in the lung model was given for all measurements. In the dry and cold air, the results from all three test systems coincided almost perfectly with the reference values. The measured BEC in the humidified and warmed air using sample-extraction systems II and III corresponded to a high degree with the reference, while in the case of PES I, only a moderate linear correlation was achieved. The temperature and humidity of the expired gas during artificial respiration influence the gas samples extracted for the purposes of BEC measurement. Newly developed sample-extraction systems II and III coincide with the reference system, even under respiration-simulated gas conditions.