39. Music, rhythm and reverse sensory tricks

Music, Rhythm and Reverse Sensory Tricks

A  Baclground

Survey results and anedotal reports  revealed that rhythm seems to be a factor in dystonic response and in sensory tricks. People with cervical dystonia sometimes report that the symptoms are less when they dance.  Some with dystonia in the legs report that they difficulty walking but the regular motion and different stride of running is easy. Some report that dystonia  affects speaking differently than it affects singing. Some with vocal cord dystonia report that the voice is suddenly much better if they assume an unusual pitch, fake an accent or speak in baby talk.

B. Areas of possible future study

These phenomena suggests some useful areas of possible future study.

delay and response time

As in the study of movement, there is often a delay reported by people with dystonia between the decision to move and the ability of the body to move. This seems not just in reaction time but at an earlier stage, of gating, and has been examined in clinical studies.
One might assume that any need for  repeated motion would compound the delays. However with some motions it seems that the brain considers the task in a slightly different category in such situations and may view the product or end result more as a whole and a goal. Some musicians report that their dystonia seems less if they focus on the whole piece not the difficult section of it.

45 second rule

Some patients report that the pain of dystonia has a pattern. A given position may be extremely painful so the person shifts out of it, nearly subconsciously to a new position.  This new position creates no pain and is a relief and yet they report that in that position pain starts to build up. By 45 seconds the pain is so intense they find they are shifting position again to escape it. This shifting and reshifting to avoid pain happens many times an hour and may account for the gait of patients who seem to jerk around and wobble as they move down the street, or who frequently are adjusting head position.  However what is reported is that for a few seconds in each new position there is no pain.

With music, dance and any other activity that requires a change in muscles within that 45 second interval, it seems possible to never quite reach that extreme pain status .This may explain why dance, regular shoulder shifting, bouncing as  person walks seems to reduce the dystonia

pitch, volume and intent

The brain not only directs the vocal cords to open and shut but also to thicken or stretch. It  also directs the vocal cords for many finger aspects of sound production including volume, pitch and emotional tone.  It may be that dystonia only affects some registers of those features, for instance normal pitch but not very low or very high pitch. It may be that it affects normal volume but not the required muscle change for high volume.  It may be that it affects normal emotional tone but not tone of crying, or of playfulness such as faking a voice or talking baby talk.  The sensory tricks reported with vocal cord dystonia may reveal actually that dystonia is only operating in some aspects of voice control, though those are usually the normal ranges.

C. Factors involved

1.Pitch- how high a note

Pitch does seem factor for falsetto voice ,baby talk sensory tricks. It also seems a factor when singing is easy but speaking is not

2. Volume – how loud a sound, amplitude

Volume seems a factor when yelling is easy but whispering is difficult

3. Intent – gravitas of voice, formal vs playful, real versus fake, intonation

The intent or emotional tone of a sound does seem a factor for baby talk or foreign accent or falsetto sensory tricks. When some report that their voice is worse in public than in private or worse in performance than in practice, this factors seems involved.eem a factor for practice versus performance difference in phone . When people report that their voice is suddenly normal when calling 9-1-1 in crisis, or when talking to their grandchildren or pets, this may be a factor. It would be easy to mistake this sudden shift as due to emotion or stress. However there may be a brain direction factor involved also, that some speech production is governed differently based on the desired emotional tone.

4. Length of sound

Lung function is not usually changed with dystonia but it seems that

some patient sshorten their  breath and less often take a deep breath. This

may be because they are in constant pain or may be due to worry. It would be useful to study if ability to take a deep breath is altered in dystonia..  Some report that a deep breath can be fully experienced, drawing in air and expelling air but there is  choppiness in inhalation while exhalation is not impaired.

It may be useful to study whether those with dystonia can hum or sustain a sound             or word as they wish.

5. Pauses

When people have to clap hands, stamp feet or snap fingers they are required to create motion in a rhythmic way.  When they are required to sing along to a recording they also have to match someone else’s set rhythm. .If people with dystonia have problems with such activities that may be due to the gating effect. People with multiple sclerosis also report delays in ability to clap hands or sing along.

Vocal cord dystonia often has choppiness or breathiness in production of the

sound . The vocal cords either stay open or stay closed in an abnormal 

way and the vibrations they can produce are therefore less predictable.

The jerkiness of the sound seems similar to jerky movements of those

with limb dystonia or to spasms of those with cervical  dystonia.  The gating effect bears study.

6. Flow of sounds, links between them

Music, dance and humming have in common not just that dystonia often is less with the flow, but that there is a smoothness to the desired motion or speech, as if the need to link the sounds results in  a different instruction from the brain.

With music however, the situation requires shifts in vocal cord, shifts in body movement sooner than that 45 second interval and a person is able then to enjoy the lower intensity of dystonia at every new position. as long as they keep moving, or singing, or humming.

A person with dystonia may therefore be able to sing along to a recording even though they may not be able to clap along to the recording. This could be studied. A person who is singing and clapping may find this particularly challenging because vocally the flow of the notes together may make the dystonia less, but clapping may be delayed because the motions do not flow together but are each separate and risk delays. So a person cannot in essence clap along to their own singing.

7. The nature of rhythm and dystonia

The body has many natural rhythms- breathing, pulse. People have levels of sleep, we know that brain messages travel in waves and we experience rhythmic shudders of cold or fear normally.  Humans are  bodies with a rhythm built in. Bodies have rhythms in utero  hearing the mother’s heart beat and are comforted by rocking as newborns. The body is on a timer, to  get sets of teeth, have growth spurts and to have changes of hair color, all along a natural and fairly predictable timetable.


It may be useful to study whether dystonia is an upset of a basic brain message about timing. In the case of cervical dystonia it seems an error of the timing of ‘\let go now’.  It retains the tightness message inappropriately and unnecessarily long.

With vocal cord dystonia the message to vibrate the vocal cords seems mistimed. In dystonia of the eyelids the message to open and close seems stuck on ‘close’.

The jerky motion of someone with dystonia trying to walk seems also a mistiming.

D. Results from various surveys

a. pitch change affects dystonia , whistling, laughing, crying

75.00% My laugh still sounds normal (29-14)

25.00% My voice is better when I laugh (29-14)

25.00% I can still easily whistle (29-14)

20.00% Since dystonia my singing range has changed – eg from soprano to alto (29-17)

b. dystonia seems less when singing or humming

75.00% I have trouble speaking but can still sing well (29-14)

40.00% When I am reading aloud, it helps if I sing the words (29-17)

36.67% My dystonia is less if I sing( 8-32)

20.00% The dystonia is less if I hum (30-15)

12.20% My eyes close less when I hum (5-17)

8.33% My dystonia is less after I do singing exercises ( 8-37)      

4.88% My eyes close less when I sing (5-17)      

c. singing, humming less possible since dystonia

40.00% I can no longer sing along to radio or for pleasure (29-17)

20.88% I sing less (3A-28)

14.29% It is hard for me to arrange my mouth sometimes to sing (7-17)

d. dancing, bouncing, jumping

66.67% It is hard for me to dance(32-6)

21.88% Does dancing seem to reduce the dystonia? Yes (13-31)

12.50% As I walk it is easier if I bounce or dance a bit (25-15)

e. the rhythm comes from the body – tremor, tingling  zaps, light flashes

50.00% I sometimes have involuntary rhythmic head shaking (23-19)

35.00% Tremors happen after I  move then settle back to dystonic position (23-19)

33.51% Occasionally I have tingling of some parts of body (2A-35)

33.33% Since dystonia I get more light flashes that dance around the room (27-3)

30.56% Some relatives have tremor, rhythmic oscillation of head, voice or hands(19-57)

30.43% I sometimes get electric type zaps in some parts of my body (23-6)

26.09% The vibrations feel like a low volt current buzzing (23-6)

25.00% Tremors happen when I try to move from dystonic to normal position (23-19)

23.24% Often I  have tingling of some parts of body (2A-35)

21.74% I thought I was near an electric outlet or my cellphone was ringing  (23-6)

ability to respond in rhythm – clapping, tapping stomping feet

33.33% It is hard for me to stomp my feet rhythmically (32-6)

23.53% I can’t tap each heel on the ground (12A- 7)

11.76%   I can’t tap toes of either foot on the ground (12A-8)

4.00% It is not possible to clap my hands in time to music (11A-15)        

f.  effect of external source of vibration

40.00% Transcutanial electrical nerve stimulation reduced my pain (38-3)

20.00% Electrical stimulation pads reduce the tremors (38-3)

12.50% I sleep well with a vibration near me like on a train or airplane (25-19)

g. music demands have triggered the dystonia

69.23% Dystonia interfered with playing music or a hobby  (17A-45)

21.43% The dystonia started as I  prepared a difficult new musical number? ( 11B- 5)

10.26% My playing music requires precise repeated hand movements (19-19)

6.00% I have dystonia playing a musical instrument but not acting out playing it (4-19)

3.85%  My hand cramps only when I play my favorite musical instrument (11A-   21)

h. music soothes the dystonia

9.09% I appreciate music more now (21-29)

25.00% It is less when I listen to music I like (13-52)

25.00% I sleep well with soft music, sound of waves, lulling voice on tape (25-     19)

E. Analysis

When people laugh or cry they make vibrating noises in a rhythm. Respondents to the surveys noted that sometimes the dystonia seems less if they are laughing or crying which suggests that the demands on the vocal cords during those activities differ from during speech. The difference may be pitch or rhythm or both.

The voice seems affected two ways with dystonia. For those with vocal cord dystonia singing seemed still possible in many cases though speech was difficult. However for some whose dystonia was in the mouth or jaw, singing was more difficult technically.    Those with blepharospasm who reported that their dystonia is less when they sing or hum are noticing an absence of dystonia at those times, consistent with some with vocal cord dystonia.

The ability to sing along with a radio or with a choir is somewhat different from the ability to sing since alone a person can create their own rhythm adjustments but trying to match an external source they cannot.  Since dystonia sometimes involves a lag or delay in response for movement, it may be that there is a similar lag in response for vocal cords and that this would be most problematic when trying to match the rhythm of others such as in group singing or chanting or group recitation, or singing along to the radio.

The 45 second observation by which pain only becomes unbearable in a new body position after 45 seconds,may explain how changing positions before 45 seconds have elapsed, reduces pain This effect may be an explanation for why dancing seems to reduce dystonia and even why bouncing as a person walks changes position just often enough to keep the pain from developing.   Those with dystonia of the legs and feet do not report benefiting from any 45 second principle however or advantage of frequent position change during dance. That may be because the complexity of the motion required with its delays is so difficult technically that any rhythm advantage is minor.

Involuntary jerking motion does not seem always rhythmic. Nor does wobbling gait. Some of these motions may be complex adjustments the body is making to dystonia pressure.. However respondents reported that their bodies have some rhythmic activities or responses. Tremor and spasms usually are rhythmic and though their vibration speed is rarely calibrated, anecdotally patients say that it slows after a time and has variations.  These could be studied.

Odd body electric sensations or zaps, internal vibrations anecdotally are reported as erratic and unpredictable but when they happen seem rhythmic and fast, like a buzzing.  This phenomenon may be useful to study.

The reports of light flashes dancing around the room may not be statistically significant and it is not clear if they are linked to actual eye problems or medication,. However if not, they also may be useful to study for they are not only light but also light with rhythm.

Head shaking in fixed rate rhythmic oscillation was reported by some respondents but also in some of their family.  The phenomenon  may be useful to study to see how it is distinguished from other conditions such as essential tremor, technically, and if the speed of the shaking varies and when.. One might also notice though that a family link to dystonic symptoms may suggest a genetic predisposition to having dystonia, or a genetic predisposition to reacting to some medications by developing dystonia. In that regard, family links may be key areas to study but they may also be small real world samples of who should not be prescribed certain medications.

Ability to tap toes, stomp feet or clap hands seems impaired in those with dystonia of the hand or feet , even though music and rhythm make dystonia less for other types of dystonia. It may be that the delay of response, and the gating phenomena are so difficult to work with technicallythat any advantage of rhythm is minor.  This technical difficulty seems similar to that experienced by those who can sing but cannot sing along to the radio.

Vibration from outside the body adds a new rhythm. This seems to  be comforting for some  respondents as they ride on  a train or airplane and for some who get electrical nerve simulation as a kind of massage. However not all respondents report this effect.

The technical playing of music is often what triggered dystonia in those who play piano, guitar, or wind instruments.  Though musicians are likely among those who enjoy music most and are deeply emotionally engaged with it, the joy of it does not seem enough to override the technical challenge of repeated precise motion.

Respondents indicated that music is often a source of comfort though the reason was not made clear. It may be that emotional connection or rhythm provides a lulling rocking reassurance or even a validation of current emotions.

It seems likely that the area of the brain that controls music is not often affected by dystonia. The music control area does not often seem affected in some other brain related conditions such as Alzheimer’s. Understanding why may prove very useful.

E.  Reverse sensory tricks and what they may suggest about rhythm and dystonia

The category of ‘reverse sensory tricks’ seems odd, given that it is failure to have an odd result, failure of a surprising reduction of dystonia.

Some report that  dystonia is less if they are near a vibrating object, hear a furnace or fan nearby, are in a vehicle like an airplane or train with constant vibration. The dystonia seems less for some people when they listen to music, or when they are rhythmically massaged.

However there are others who not only do not feel better in those circumstances but who actually feel worse.  For some patients a massage makes their spasms worse and some report that they have an attack or dystonic storm if they are massaged.

Survey 19-45 asked if  a nearby vibration affected the dystonia.

16.67% said it is comforting and makes it better

58.33% said it has no effect

25.00% said it makes the dystonia worse

The variation of response could be studied.

One hypothesis is that external rhythm that is in sync with body rhythm is comforting but external rhythm not in sync is not. People with epilepsy can have a seizure if they are exposed to lights strobing at  a certain interval. Most people have the experience on looking out a car window of feeling uncomfortable,dizzy or nauseated if they watch telephone poles passing at a certain speed.  It may be useful to study whether dystonia as an error of message from the brain about rhythm of response, is strongly affected then by another rhythm in the environment.

A study of the oddities of rhythm and dystonia in these surveys shows

-Deep breathing relaxes 17.58% of respondents

            Deep breaths have no effect on 40.11% of respondents

            Deep breaths cause gentle spasms in 7.69% of respondents

-Rubbing the dystonic muscle helps 50.00% of respondents

            and does not help 50.00% of respondents

-Dancing seems to reduce the dystonia for 21.88% of respondents

            but not for 43.75% of them

-Exercise is reported to help by 14-60% of respondents

            33.65% say it has no effect

            Howevr 20-60% say that exercises can be painful, make them stiffen u

                        or go into spasms

-Swimming helps 12.90% , has no effect on 9.69%

            and makes the dystonia worse for 50.00%

-having a nearby fan as they sleep helps 16.13% of respondents relax

            has no effect for 41.94%

            but actually keeps 9.68% from being able to relax