The neural consequences of repetition: clinical implications of a learning hypothesis

Repetitive strain injuries (RSIs) are difficult to treat. Some individuals with RSIs may ultimately develop chronic pain syndromes or movement problems like focal hand dystonia (FDh), a disorder of motor control manifested in a specific context during skilled, hand tasks. This paper reports on the results of four neuroplasticity studies suggesting that repetitive hand opening and closing can lead to motor control problems, measurable somatosensory changes, and problems in graphesthesia and stereognosis. The experiments support a learning hypothesis for the origin of severe RSIs, particularly FDh. This degradation in the sensory representation of the hand may not only explain the therapeutic challenge of returning these patients to work, but also provide a foundation for developing more effective physical rehabilitation strategies. Implications and conjectures for the applications of this learning hypothesis to conditions of chronic pain are also discussed.