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A unifying motor control framework for task-specific dystonia

Abstract

Task-specific dystonia is a movement disorder characterized by a painless loss of dexterity specific to a particular motor skill. This disorder is prevalent among writers, musicians, dancers and athletes. No current treatment is predictably effective, and the disorder generally ends the careers of affected individuals. Traditional disease models of dystonia have a number of limitations with regard to task-specific dystonia. We therefore discuss emerging evidence that the disorder has its origins within normal compensatory mechanisms of a healthy motor system in which the representation and reproduction of motor skill are disrupted. We describe how risk factors for task-specific dystonia can be stratified and translated into mechanisms of dysfunctional motor control. The proposed model aims to define new directions for experimental research and stimulate therapeutic advances for this highly disabling disorder.

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Figure 1: Motor hierarchy in skill learning.
Figure 2: Evidence for a motor hierarchy.
Figure 3: Components required for skill performance and the dynamic interactions between risk factors.
Figure 4: Vulnerabilities of highly skilled representations.
Figure 5: The development of task-specific dystonia.

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Acknowledgements

A.S. is funded by a Guarantors of Brain Clinical Research Fellowship and a Chadburn Clinical Lectureship. K.K. is funded by Sir Henry Wellcome Fellowship no. 098881/Z/12/Z. M.J.E. is partially funded by a UK National Institute for Health Research (NIHR) grant.

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A.S. and K.K. collated data and papers relevant to the article, developed its content, and wrote the manuscript. J.C.R. and M.J.E. contributed substantially to discussions of the article content and to review of the manuscript.

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Correspondence to Anna Sadnicka or Katja Kornysheva.

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Competing interests

A.S. and K.K. declare that they have no competing interests. J.C.R. declares that he has received speaker's travel costs from the Movement Disorders Society. M.J.E. declares that he receives royalties for the Oxford Specialist Handbook of Parkinson's Disease and Other Movement Disorders (Oxford University Press, 2008) and that he has received speaker's honoraria from UCB pharmaceuticals.

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Glossary

Automaticity

A mode of motor control in which movements operate with very little conscious knowledge of the actions required to perform them.

Chunking

Collection of elementary units that are inter-associated, stored in memory as one unit, and act as a coherent, integrated group when retrieved.

Dystonia

A movement disorder characterized by sustained or intermittent muscle contractions causing abnormal movements, abnormal postures or both.

Individuation

The degree to which a single finger can move without unintended movements of the other fingers of the same hand.

Motor hierarchy

A functional hierarchy of the motor system, with each level having specific roles in motor encoding and control of movement.

Motor synergies

Elemental action units, characterized by groups of weighted muscle activations that are coordinated in space and time.

Representation

Activity in neural substrates containing information about the external or internal state of the system, including motor output.

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Sadnicka, A., Kornysheva, K., Rothwell, J. et al. A unifying motor control framework for task-specific dystonia. Nat Rev Neurol 14, 116–124 (2018). https://doi.org/10.1038/nrneurol.2017.146

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