Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) program: exercises with augmented movement feedback associated to botulinum neurotoxin in idiopathic cervical dystonia—an observational study
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Idiopathic cervical dystonia (ICD) is a focal dystonia affecting neck muscles. Botulinum neurotoxin (BoNT) is the first-line treatment of ICD and different physical therapies (including exercise) are often proposed as adjunct treatments. However, the actual effectiveness of exercise in ICD is unclear. The aim of the current work is to assess the potential effectiveness of the Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) exercise program as adjunct therapy for ICD.
Fifteen ICD patients received BoNT injections in the neck muscles and, 12 weeks later, received BoNT a second time and SPRInt started. SPRInt consists in 18 exercise sessions in which augmented feedback of movement (including visual and acoustic feedback) is extensively used. Dystonia burden was measured by the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). Patients were evaluated immediately before, 6 and 12 weeks after each BoNT injection.
Six weeks after the first BoNT injection (i.e., at BoNT peak effect), TWSTRS total score was better than baseline and remained improved at 12 weeks. TWSTRS disability domain slightly improved 6 weeks after the first BoNT injection, but after 6 more weeks returned to its baseline level. Disability improved more at SPRInt end (i.e., 6 weeks after the second BoNT injection), being even lower than after toxin alone. With a single-subject analysis, 4/10 patients who did not improve disability after BoNT improved after SPRInt plus BoNT.
SPRInt plus BoNT can be more effective than BoNT alone in improving cervical dystonia patients’ difficulties in the activities of daily living.
KeywordsCervical dystonia Botulinum toxins Type A Exercise Physical therapy modalities Neurofeedback Rehabilitation
We are particularly grateful to the patient who agreed to appear in the video attached as supplementary materials.
This research was supported by the financial contribution of Italian Ministry of Health-Ricerca Corrente.
Compliance with ethical standards
Ethical aspects of the study were reviewed and approved by the local ethic committee (Comitato Etico “IRCCS Fondazione Don Carlo Gnocchi”, Comitato Etico Centrale IRCCS Regione Lombardia) and the study has been recorded at ClinicalTrials.gov (NCT03247868). Each participant gave his/her written consent to take part in the study. The patient who agreed to appear in the video attached to the current work as Supplementary Materials 2 gave her written consent to publication.
The other authors declare that they have no conflicts of interest. Alessandro Crippa created the feedback system used in the study (Leonardo, produced by Chinesport).
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