After twenty years, the famous Maestro João Carlos Martins is finally able to play piano again, thanks to modern technology. In his case, it was a pair of bionic gloves that helped his fingers tickle the ivories after such a long break. What hindered his playing was focal dystonia, the loss of control over long-practiced fine motor movements. It is a common illness of professional musicians. In celebration of Maestro Martins’ comeback concert, we talked with Prof. Dr. Eckart Altenmüller about how his research resulted in today’s treatment of focal dystonia, his thoughts on bionic gloves, and what composer Robert Schumann and Maestro Martins have in common.
What is focal dystonia, also often called musician dystonia?
Focal dystonia is the loss of control over long-practiced fine motor movements. The term ‘focal’ means that it usually affects only one limb, for example, the left or the right hand; and dystonia means abnormal muscle movement. For musicians it often occurs at the peak of their career, when arbitrary movements such as fine coordinated movements on the instrument are disturbed.
How do you get the disease?
There is a strong connection with the length of practicing time: how much time and how many years you spent practicing, repeating the same movements over and over. Other risk factors are, for example, a history of chronic pain, starting late in life with practicing, or genetic factors such as family members who suffer from Parkinson’s or something similar.
Is there a cure?
This is a learned disease that can be unlearned. It is a matter of disturbed neuronal networks. They are malleable, they are adaptable. Although the movements are different after recovering from dystonia, the symptoms can be alleviated and you can modify your repertoire in such a way that you can still make music at the highest level. This is part of the rehabilitation process.
For Maestro Martins help came in form of bionic gloves. They helped him play again. How do they work?
There are two effects. The first is the so-called sensory trick. All movements are tied to feelings in the hand. If I change the feelings in the hand, I usually change the movement for the better. The second effect is that the gloves can counteract the cramping tendency and the involuntary retraction of fingers, in addition to relieving the muscles of the forearm.
Bionic gloves have two effects – the sensory trick and counteracting the cramping tendency. (photo credit: Jean-Claude Kuner)
So bionic gloves are doing the magic trick?
No, they are still being developed. They are not yet able to handle highly complex, very fast finger movements like trilling accurately down to the millisecond. It has brought Maestro Martins a certain relief, but you can see clearly that he does not have his former virtuosity.
So why are the bionic gloves from Maestro Martins are getting so much attention?
Maestro Martins has a very honorable motivation in promoting his story. He wants to improve the lives of professional musicians. Focal dystonia is the most frequent occupational hazard for musicians. And even today there is a need to make this disease known.
What do you mean by that?
The diagnosis for focal dystonia has only been known since 1992. Back then, it was very unexplored and most of the affected musicians experienced a years-long journey similar to João Carlos Martins. And although we are able to diagnose focal dystonia a lot earlier and better today, we have more to learn about prevention methods such as healthy practicing and good self-management. Today, the focus needs to lie more acutely on the psychological consequences of a musician’s dystonia.
Can you explain that in more detail?
All of our motor activity is a constant expression of our emotions and an expression of our psyche. If I have a very rigid mind, then my musculature automatically becomes rigid. The pressure musicians are under nowadays is much greater than in the past. Paganini just went on stage and played what he enjoyed. Today we have 20 reference recordings for comparison. So, our therapeutic measures are also geared toward relieving the Four Horsemen of the Apocalypse coming with musician’s dystonia: the anger that you are practicing and it is not getting better, the shame that colleagues do not understand your problem, the guilt that you have overworked yourself, and the fear about whether you can continue your profession at all.
How does it feel to see how your research results are translated into practice?
For me it is a great success, a very satisfying activity. I have been at the Institute in Hannover for 28 years doing this musician clinic/consultation with a focus on dystonia. Since then, I have treated over 2,000 patients. And today we are in a position to offer so many therapeutic options, which we have developed over the last 30 years. It’s a great feeling for me.
Thanks to bionic gloves Maestro Martins is able to play piano again. (photo credit: Jean-Claude Kuner)
How would you have helped Maestro Martins?
The standard treatment is to start with retraining. Retraining means that you learn to perform the movements correctly again. This includes putting obsessive behavior into perspective. Freeing the patients from the pressure to succeed. In addition, there are currently two medications that work very well on dystonia.
The wrong movements in his hands I could have treated with a carefully dosed local injection of botulinum toxin, so that he no longer cramps his fingers, but still has enough strength to strike the piano keys. And finally, and maybe most importantly, I would have encouraged him to move to composing and conducting much earlier and make himself less dependent on his hands.
Why is finding new ways as a musician so important?
He has the best example before his eyes: Robert Schumann, who also suffered from focal dystonia. Imagine if I had treated Robert Schumann. That would have been a disaster. He would have become one of the nameless, Romantic piano virtuosos that no one knows today. Now, fortunately, he is one of the greatest Romantic composers of his day.
Would Schumann have jumped at the chance to wear bionic gloves?
No, not at all. In a letter to his mother, he wrote “Don’t worry about my fingers. I can compose without them, and I wouldn’t have been suitable for a traveling virtuoso in the first place.” He had very good self-awareness. And I think that’s the task for all of us – that we find solutions with the resources we have available and adapt if necessary. And if I am a very musical person, then I can develop and refine musical skills without my hands and pass them on to others.
Prof. Dr. Eckart Altenmüller is Full Professor and Head of the Department of Music-Physiology and Musician’s Medicine at the University for Music Drama, and Media, Hannover since 1994 and a leading expert on the topic of focal dystonia. His research focus is on brain processing of music and motor learning in musicians. If you are interested in more details regarding Schumann and focal dystonia, have a look at his book chapter “Robert Schumann’s Focal Dystonia” written by Prof. Altenmüller. You may also be interested in our article collection about dystonia.
What is it like to work in two roles at the same time? Samuel Lei, Executive Assistant of CPM and Rights & Permission Manager, shares his insights and what he appreciates most about Karger at the moment.
Take us through a day in your work life. What are some of the work habits you’ve developed over the years that help you maintain productivity?
There are two things that come to my mind. First, as I have to switch roles between being Executive Assistant of CPM and Rights & Permission Manager (where I share responsibilities), I try to separate my tasks like working on Rights & Permission emails only after lunch.
And secondly for bigger tasks where I need to brainstorm or focus on one subject at a time, you can call this deep work, I block 1-2 hours in my calendar. During this time I focus only on this one task/project, without the distraction of emails or Teams chat; which I shut down during this block.
What motivated you to apply for a position at Karger?
I’d rather answer the question “What motivated me to say yes to a position at Karger?”. I decided to sign my contract because I sensed back in mid-2017 that there is not only change happening at Karger, but also a lot of opportunities waiting for me. I felt Karger was an employer I’d like to work at right from the beginning. From my point of view this has not changed, which apparently also has a lot to do with the team I am working in – CPM.
What has been your experience during the remote work over the last two years?
Lots of flexibility, which brings freedom but responsibilities at the same time. I was able to quickly adapt to this and learned that there is always a chance to grow when facing a crisis.
What do you enjoy the most about your time at Karger?
Being involved in different kinds of activities, tasks and departments like answering requests for reuse of a table from an article in Rights & Permission, researching a healthcare topic, making the publication plan of CPM available internally, working with international clients or making short introductions to CPM to new employees at Karger. Also, I find the wide variety of departments that I am working with interesting. And so on … Actually, there is a lot more that I like about working at Karger.
What would you like someone who’s interested in applying to Karger to know?
The currently implemented remote guidelines and the flexibility that comes with it. I appreciate this a lot, since I have kids myself. This working mode comes with, as I said earlier, more responsibilities but also more freedom in terms of work-life balance. Sometimes this is dismissed as lip-service instead of acknowledged as something that actually is being done. Karger has acted with integrity when it comes to this matter, which cannot be appreciated highly enough from my point of view.
What publications do you read most, podcasts you listen to, any books you are currently reading?
I read fiction as well as non-fiction. To try to be a better human being and work on being happier in life I’d recommend to aim for a book a week. If that’s too much, cut some of your daily news, which in larger amounts can be toxic anyway, in my opinion. There is no other shortcut to getting there (being happy and fulfilled). If that makes sense … at least it does for me.
Are you interested in a career at Karger? Explore our current job opportunities at our job portal. Also, find out what Stephanie does in the role as a “Strategy, Innovation & Venture Specialist”.
This November the University of Basel awarded Gabriella Karger, Chairwoman of the Board of Directors at Karger Publishers, an honorary doctoral degree. Gabriella Karger thereby joined a family tradition: both her grandfather and her father were also given this honor. In an interview Gabriella spoke about what this honorary degree means to her and why she would like to share the credit.
Gabriella Karger receiving the honorary doctorate
© University of Basel, Christian Flierl
Congratulations, Gabriella, on receiving your honorary degree from the Faculty of Medicine of the University of Basel. What was your first thought when you heard the news?
“Wow, that’s great! What an honor! That’s wonderful.” But since I’m a modest Basler as well it was also a little embarrassing. I was just doing my job. But of course I was overjoyed about it, especially for the publishing house. The distinction shows how much we all accomplish together, the Karger team.
What does an honorary degree mean to you?
This distinction is something very special to me. The Faculty of Medicine at the University of Basel has a very good reputation. Being honored by Basel means that I was able to carry this good reputation of my hometown, and of the seat of this publishing house, out into the wider world, and that I can continue to do so.
Moreover I see myself as the representative of my generation, which is why I would like to dedicate this honor to the memory of my brother Steven, who led this business until he passed far too young.
Why were you given this honorary degree?
From the activities that were listed by Professor Schär, the dean of the medical faculty, in his Laudatio address, I would emphasize two of them: the support of young researchers, and scientific communication.
We support the development of young researchers at the University of Basel by taking part in the annual science month of the Faculty of Medicine for over ten years now . Moreover it will soon be twenty years now that we’ve been involved with the Faculty of Psychology in funding the Steven Karger Prize for the best dissertations.
Internationally, we began in 2020 by establishing the Vesalius Innovation Award focusing on startups in the health sciences and scientific publishing.
And what were the reasons for the honorary degree involving scientific communication?
We published the masterpiece of the anatomist Andreas Vesalius in an English translation; that was something special and unique for me. Vesalius wrote medical history more than 500 years ago with his atlas “De Humani Corporis Fabrica” and is rightly called the father of anatomy. The English translation of his oeuvre is important for an understanding of all of medicine — both historically as well as for the future.
For this reason I have also pushed for the digitalization of all Karger publications, so that now practically every text we publish is available online — medicine can also learn a lot from history.
With our efforts in the domain of open science we are taking our traditional role of making medical content as broadly available as possible into the future. We would like to make new scientific findings openly accessible in order to advance the health sciences. Here a sustainable transformation is important to us to ensure that the interests of all our stakeholders are still upheld.
All of these projects are planned and implemented together with many other Karger employees. Is the honorary degree a distinction for the entire Karger company?
Yes, absolutely. We all live the idea of “Connecting and Advancing Health Sciences”. This is not the achievement of any individual. For this reason I accept this distinction as the bearer of the Karger name for all who help to carry Karger. For me as an entrepreneur it is very clear that this distinction was earned by many people together. Besides the staff of Karger Publishers I also share this distionction with my family, who have supported me and us as a family business in everything.
What does the company mean for your family?
Very much! We all agree that we absolutely wish to continue this business. Of course none of us know how the industry will change and what challenges we will face. It is important that the family shares an engagement, interest and understanding for the company.
Your grandfather, Heinz Karger, and also your father Thomas were both given the honorary doctorate. How was that at the time?
I can remember very well when my father received the honorary degree in 1993. It meant a lot to him, because he had to take over the company as a 29-year-old after the sudden death of his father. It was a validation of his work, for him, also because Basel and the close contact with the university were particularly important to him. Unfortunately he can no longer see the ceremony this year. He certainly would have been more than proud to see me also received the same distinction.
What does this distinction mean for Karger as a publisher?
It is a confirmation that Karger Publishers is pursuing the right strategy. Like those before me, we offer an important platform for the exchange between scientists by publishing their research following its assessment by their peers. But research is never finished, especially if it fails to look at the bigger picture. The clarification of the research for the clinical and practical context has to be ensured as well as conversely informing researchers of the feedback from patients and doctors. The Karger publishing house has a rich history and I’m happy to continue writing this history together with my family, with all the Karger staff, and with our important partners in the sciences, in industry and in publishing.