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Sensorimotor Perceptive Rehabilitation Integrated (SPRInt) program: exercises with augmented movement feedback associated to botulinum neurotoxin in idiopathic cervical dystonia—an observational study

  • Anna Castagna
  • Antonio CaronniEmail author
  • Alessandro Crippa
  • Luciana Sciumè
  • Giulia Giacobbi
  • Chiara Corrini
  • Angelo Montesano
  • Marina Ramella
Original Article
  • 99 Downloads

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

SPRInt plus BoNT can be more effective than BoNT alone in improving cervical dystonia patients’ difficulties in the activities of daily living.

Trial registration

www.ClinicalTrials.gov, identifier NCT03247868 (https://register.clinicaltrials.gov).

Keywords

Cervical dystonia Botulinum toxins Type A Exercise Physical therapy modalities Neurofeedback Rehabilitation 

Notes

Acknowledgements

We are particularly grateful to the patient who agreed to appear in the video attached as supplementary materials.

Funding support

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.

Competing interests

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).

Supplementary material

10072_2019_4061_MOESM1_ESM.docx (180 kb)
Supplementary Materials 1 (DOCX 180 kb)

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Copyright information

© Fondazione Società Italiana di Neurologia 2019

Authors and Affiliations

  1. 1.U. O. di Recupero e Rieducazione FunzionaleI.R.C.C.S. Fondazione Don Carlo Gnocchi OnlusMilanItaly
  2. 2.U. O. di Medicina riabilitativa e neuroriabilitazioneOspedale NiguardaMilanItaly

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