focal dystonia of musicians within the framework of the Till Approach: it is not about mindless drills or separate rehabilitation, but about the conscious building of a new motor strategy that gradually becomes the playing itself.

Nora Krohn, a violist and teacher based in New York, describes a fundamental change in how we understand the term "practice" in her approach to recovery from focal dystonia. She emphasizes that the Till Approach is not about a separate rehabilitation phase or mechanical technical drills, but about the gradual building of a new motor strategy, which eventually becomes playing itself.

The traditional concept of exercise and its pitfalls

In classical music education, scales, etudes and technical exercises are often perceived as a necessary basis of technique. The problem, according to Krohn, is that these exercises tend to be performed automatically, without conscious attention to what movement is actually happening in the body. If focal dystonia is present, the dystonic movement pattern can be unconsciously reinforced in this way.

A typical example is practicing "on autopilot", such as playing scales while watching TV. In such a case, the movement is repeated, but without correction and without creating a new, functional alternative.

Rehabilitation model: exercise as a means

In fitness or physiotherapy, exercise is usually understood as a means to better functioning in everyday life. Exercises are not a goal in themselves, but a tool to achieve another activity, such as pain-free walking or a stable grip. However, according to Krohn, this model cannot simply be transferred to recovery from dystonia while playing a musical instrument.

If, after "rehabilitation" exercises, the player returns to the same way of playing that originally created the dystonia, the change remains superficial or short-lived.

Till Approach: exercise as part of playing

In the Till Approach, exercises are not separated from the playing itself. The individual practiced elements represent the building blocks of the technique and directly form a new motor program. What is consciously practiced in the first part of the practice is only applied to specific musical material in the second part.

In other words: it is not a transition from "practice" to "play", but a smooth continuation of the same experience. Music is not a new activity, but an extension of an already built movement solution.

Conscious attention and discrimination of movement strategies

A key role is played by the ability to consciously perceive what is happening in the body. Krohn emphasizes the need to distinguish between different movement strategies and learn to purposefully choose a solution that is stable, sustainable and non-dystonic. This process is highly individual and often requires the guidance of an experienced educator.

The goal is not to control every detail of movement forever, but to create a reliable alternative that the brain will gradually accept as the new norm.

Late phase of recovery: return to the musical impulse

In the later phase of recovery, the conscious "deployment" of individual elements is gradually abandoned. Once the new motor program is sufficiently stable, movement control can again be based primarily on musical intent and impulse. It is music that becomes the main organizing element of the movement.

However, this transition is a slow and sensitive process. It cannot be rushed and cannot be circumvented by mechanical exercise. The basis remains the understanding that the practiced movements are not preparation for playing, but its very basis.

Source: transcript of Nora Krohn's video on the role of exercise in recovery from focal dystonia.