Objective: To determine alternative neural pathways for restitution of piano playing after right hemispheric infarction causing left arm and hand paralysis.
Design: Case report testing coordinated bimanual skills using structured motor skills tests and neuroimaging.
Setting: A professional pianist sustained a lacunar infarction in the posterior limb of his right internal capsule, which resulted in left hemiparesis with immobilized left-hand and -finger movements persisting for 13 weeks. After 6 months, he had recovered bimanual coordinated piano skills by "ignoring" his left hand while concentrating or discussing subjects other than music while playing.
Patient: A 63-year-old, male professional pianist.
Intervention: Detailed neurological examination including computed cranial tomography, functional magnetic resonance imaging, and positron emission tomography.
Results: Functional magnetic resonance imaging activation patterns correlated with rapid movements of fingers in each hand separately and together demonstrating that subcortical and cerebellar pathways were activated during skilled motor function of his left hand. Contralateral cerebral and cerebellar activation occurred with both left- and right-hand movements. During tapping of the left fingers, there was bilateral cerebellar, parietal, and left premotor strip and left thalamic activation.
Conclusion: Patterns of activation relate to task performance and they are not similar to subjects engaged in simpler tasks such as finger opposition.