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Abstract

This PhD investigates how musicians with Musicians’ Focal Dystonia (MFD) navigate and experience rehabilitation, with particular focus on journeys of retraining from pre-diagnosis to post-retraining. The research design combines three, mixed-methods studies to investigate MFD awareness and discourse surrounding MFD within UK conservatoires, musicians' utilisation and perceptions of retraining practices and the strategies, motivations, and perceived outcomes of self-developed retraining (SDR).

The research shows that low and inconsistent awareness of MFD amongst stakeholders, (instrumental teachers and students at UK conservatoires) contribute to diagnostic delays and poorly informed rehabilitation choices and decisions. Medical guidance provided to musicians following a diagnosis of MFD remains limited including inconsistent and infrequent signposting to non-pharmaceutical options. Retraining pathways lack structure and are marked by unclear goals and objectives, varied theoretical grounding and declining support systems over time. Retraining outcomes are mixed across methods, and progress typically occurs after extended period of time (often exceeding more than five years). The results demonstrate the complexity of the retraining process together with the significant psychological demands of recovery.

Over half of dystonic musicians that choose to retrain adopt self-developed approaches to retraining that are tailored to iteratively address problem-solving, experimental learning, and peer-informed exploration. The personalised retraining pathways combine both sensorimotor retraining methods with psychological approaches (e.g., stress regulation, trauma-informed methods) which reflects the multifactorial nature of MFD. SDR is frequently associated with increased agency and a redefinition of success, and in addition to symptom reduction, musicians report changes in identity, priorities, and practice culture including greater self-care, non-judgemental awareness, and attention to the mind–body connection.

The PhD proposes a patient-focused multidisciplinary framework to improve the retraining experience that includes prompt and clear signposting to evidence-based choices and the integration of neurological playing health principles into standard teaching practices. It also advocates for continued, structured support that connects instrument-specific needs to general retraining principles and clear retraining goals. The research suggests that MFD and performance health literacy should be included in conservatoire curricula, including teacher development programmes. Referral and communication pathways require clarification and accessible, accurate, and accredited information concerning MFD, and rehabilitation should be provided to all musicians, working towards reducing delay and confusion throughout the process.

The research reframes rehabilitation for dystonic musicians as a longitudinal and transformative learning process. It delivers useful and practical guidance to educators, clinicians and retraining professionals concerning the immediate enhancement of timely access, the customisation of retraining processes, and improving dystonic musicians’ long-term wellbeing.

Publication Type:	Thesis (Doctoral)
Subjects:	M Music and Books on Music > MT Musical instruction and study R Medicine > RC Internal medicine > RC0321 Neuroscience. Biological psychiatry. Neuropsychiatry
Departments:	Doctoral Theses

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