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Rehabilitation of Dystonia

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Movement Disorders Rehabilitation

Abstract

Dystonia is a syndrome characterized by “sustained or intermittent muscle contractions causing abnormal, often repetitive movements, postures, or both. Dystonic movements are typically patterned, twisting, and may be tremulous. It is usually classified according to its location within the body. Other classifications are based on the age at manifestation, the continuity of occurrence (continuous, intermittent, paroxysmal) and the conditions of occurrence (task-specific, action-induced, spontaneous). Causal factors may also be considered for classification: idiopathic, symptomatic owing to structural lesions, pharmacological interactions, metabolic disorders and psychogenic reactions. Dystonia may occur as an isolated symptom or in the context of other symptoms or conditions arising from basal ganglia dysfunction.

No single treatment produces complete remission of the symptoms, combinations of different treatment modalities often become necessary, and therefore treatment options and rehabilitation will be discussed in this chapter.

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References

  1. Albanese A, Bhatia K, Bressman SB, Delong MR, Fahn S, Fung VS, Hallett M, Jankovic J, Jinnah HA, Klein C, Lang AE, Mink JW, Teller JK. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013;28:863–73.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Dressler D, Altenmueller E, Bhidayasiri R, Boholega S, Chana P, Chung TM, Frucht S, Garcia-Ruiz PJ, Kaelin A, Kaji R, Kanovsky P, Laskawi R, Micheli F, Orlova O, Relja M, Rosales R, Slawek J, Timerbaeva S, Warner TT, Adib Saberi F. Strategies for treatment of dystonia. J Neural Transm. 2015;123:251–8.

    Article  PubMed  Google Scholar 

  3. Dressler D, Adib Saberi F, Kollewe K, Schrader C. Safety aspects of incobotulinumtoxinA high dose therapy. J Neural Transm. 2014;122:327–33.

    Article  PubMed  Google Scholar 

  4. Bertrand CM. Selective peripheral denervation for spasmodic torticollis: surgical technique, results, and observation in 260 cases. Surg Neurol. 1993;40:96–103.

    Article  CAS  PubMed  Google Scholar 

  5. Dressler D, Berweck S, Chatzikalfas A, Ebke M, Frank B, Hesse S, Huber M, Krauss JK, Mücke K-H, Nolte A, Oelmann H-D, Schönle PW, Schmutzler M, Pickenbrock H, Van der Ven C, Veelken N, Vogel M, Vogt T, Adib Saberi F. Intrathecal baclofen therapy in Germany: proceedings of the IAB-interdisciplinary working group for movement disorders consensus meeting. J Neural Transm. 2015;122:1573–9.

    Article  CAS  PubMed  Google Scholar 

  6. Adib Saberi F, Dressler D. Interdisziplinärer Arbeitskreis Bewegungsstörungen (IAB): a new approach for promoting interdisciplinary therapy of movement disorders. J Neural Transm. 2013;120:705–10.

    Article  PubMed  Google Scholar 

  7. Delnooz CC, Horstink MW, Tijssen MA, van de Warrenburg BP. Paramedical treatment in primary dystonia: a systematic review. Mov Disord. 2009;24:2187–98.

    Article  PubMed  Google Scholar 

  8. Bleton JP. Cervical dystonia: a physiotherapy handbook. Paris: Frison Roche; 2014.

    Google Scholar 

  9. Counsell C, Sinclair H, Fowlie J, Tyrrell E, Derry N, Meager P, Norrie J, Grosset D. A randomized trial of specialized versus standard neck physiotherapy in cervical dystonia. Parkinsonism Relat Disord. 2016;23:72–9.

    Article  PubMed  Google Scholar 

  10. Ramdharry G. Case report: physiotherapy cuts the dose of botulinum toxin. Physiother Res Int. 2006;11:117–1122.

    Article  PubMed  Google Scholar 

  11. Tassorelli C, Mancini F, Balloni L, Pacchetti C, Sandrini G, Nappi G, Martignoni E. Botulinum toxin and neuromotor rehabilitation: an integrated approach to idiopathic cervical dystonia. Mov Disord. 2006;21:2240–3.

    Article  PubMed  Google Scholar 

  12. Brudny J, Grynbaum BB, Korein J. Spasmodic torticollis: treatment by feedback display of the EMG. Arch Phys Med Rehabil. 1974;55:403–8.

    CAS  PubMed  Google Scholar 

  13. Cleeland CS. Behavioral technics in the modification of spasmodic torticollis. Neurology. 1973;1973(23):1241–7.

    Article  Google Scholar 

  14. Duddy J. Lack of influence of EMG feedback in relaxation training for spasmodic torticollis. Clin Rehabil. 1995;9:297–303.

    Article  Google Scholar 

  15. Harrison DW, Garrett JC, Henderson D, Adams HE. Visual and auditory feedback for head tilt and torsion in a spasmodic torticollis patient. Behav Res Ther. 1985;23:87–8.

    Article  CAS  PubMed  Google Scholar 

  16. Jahanshahi M, Sartory G, Marsden CD. EMG biofeedback treatment of torticollis: a controlled outcome study. Biofeedback Self Regul. 1991;16:413–48.

    Article  CAS  PubMed  Google Scholar 

  17. Korein J, Brudny J. Integrated EMG feedback in the management of spasmodic torticollis and focal dystonia: a prospective study of 80 patients. Res Publ Assoc Res Nerv Ment Dis. 1976;55:385–426.

    CAS  PubMed  Google Scholar 

  18. Leplow B. Heterogeneity of biofeedback training effects in spasmodic torticollis: a single-case approach. Behav Res Ther. 1990;28:359–65.

    Article  CAS  PubMed  Google Scholar 

  19. Spencer J, Goetsch VL, Brugnoli RJ, Herman S. Behavior therapy for spasmodic torticollis: a case study suggesting a causal role for anxiety. J Behav Ther Exp Psychiatry. 1991;22:305–11.

    Article  CAS  PubMed  Google Scholar 

  20. Andrews HB, Gill HS. Torticollis and serendipity. Arch Phys Med Rehabil. 1982;63:238–9.

    CAS  PubMed  Google Scholar 

  21. Faircloth S, Reid S. A cognitive-behavioural approach to the management of idiopathic cervical dystonia. J Behav Ther Exp Psychiatry. 2006;37:239–46.

    Article  PubMed  Google Scholar 

  22. Turner SM, Hersen M, Alford H. Effects of massed practice and meprobamate on spasmodic torticollis: an experimental analysis. Behav Res Ther. 1974;12:259–60.

    Article  CAS  PubMed  Google Scholar 

  23. Karnath HO, Konczak J, Dichgans J. Effect of prolonged neck muscle vibration on lateral head tilt in severe spasmodic torticollis. J Neurol Neurosurg Psychiatry. 2000;69:658–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Leis AA, Dimitrijevic MR, Delapasse JS, Sharkey PC. Modification of cervical dystonia by selective sensory stimulation. J Neurol Sci. 1992;110:79–89.

    Article  CAS  PubMed  Google Scholar 

  25. Rosengren SM, Colebatch JG. Cervical dystonia responsive to acoustic and galvanic vestibular stimulation. Mov Disord. 2006;21:1495–9.

    Article  PubMed  Google Scholar 

  26. Cavanaugh JA, Platt JV. Retrocollis: management with orthoplast adapted orthosis. Arch Phys Med Rehabil. 1976;57:300–2.

    CAS  PubMed  Google Scholar 

  27. Karapantzou C, Dressler D, Rohrbach S, Laskawi R (2014) Frontalis suspension surgery to treat patients with essential blepharospasm and apraxia of eyelid opening: technique and results. J Plastic Reconstr Aesthet Surg 10:44.

    Google Scholar 

  28. Bertolotti G. Biofeedback (BFB) in blepharospasm: two case reports. Appl Psychophysiol Biofeedback. 2005;30:179–80.

    Google Scholar 

  29. Brantley PJ, Carnrike Jr CL, Faulstich ME, Barkemeyer CA. Blepharospasm: a case study comparison of trihexyphenidyl (Artane) versus EMG biofeedback. Biofeedback Self Regul. 1985;10:173–80.

    Article  CAS  PubMed  Google Scholar 

  30. Peck DF. The use of EMG feedback in the treatment of a severe case of blepharospasm. Biofeedback Self Regul. 1977;2:273–7.

    Article  CAS  PubMed  Google Scholar 

  31. Rowan GE, Sedlacek K. Biofeedback in the treatment of blepharospasm: a case study. Am J Psychiatry. 1981;138:1487–9.

    Article  CAS  PubMed  Google Scholar 

  32. Roxanas MR, Thomas MR, Rapp MS. Biofeedback treatment of blepharospasm with spasmodic torticollis. Can Med Assoc J. 1978;119:48–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Stephenson NL. Successful treatment of blepharospasm with relaxation training and biofeedback. Biofeedback Self Regul. 1976;1:331.

    Google Scholar 

  34. Blitzer A, Brin MF, Fahn S, Lovelace RE. Clinical and laboratory characteristics of focal laryngeal dystonia: study of 110 cases. Laryngoscope. 1988;98:636–40.

    Article  CAS  PubMed  Google Scholar 

  35. Murry T, Woodson GE. Combined-modality treatment of adductor spasmodic dysphonia with botulinum toxin and voice therapy. J Voice. 1995;9:460–5.

    Article  CAS  PubMed  Google Scholar 

  36. van Vugt FT, Boullet L, Jabusch HC, Altenmüller E. Musician’s dystonia in pianists: long-term evaluation of retraining and other therapies. Parkinsonism Relat Disord. 2014;20:8–12.

    Article  PubMed  Google Scholar 

  37. Bleton JP. Physiotherapy of focal dystonia: a physiotherapist’s personal experience. Eur J Neurol. 2010;17 Suppl 1:107–12.

    Article  PubMed  Google Scholar 

  38. Baur B, Schenk T, Fürholzer W, Scheuerecker J, Marquardt C, Kerkhoff G, Hermsdörfer J. Modified pen grip in the treatment of writer’s cramp. Hum Mov Sci. 2006;25:464–73.

    Article  PubMed  Google Scholar 

  39. Baur B, Fürholzer W, Jasper I, Marquardt C, Hermsdörfer J. Effects of modified pen grip and handwriting training on writer’s cramp. Arch Phys Med Rehabil. 2009;90:867–75.

    Article  PubMed  Google Scholar 

  40. Gupta SK. Behavioural management of writer’s cramp: a review of the research evidence. Int J Psychol Psychiatry. 2014;2:126–39.

    Article  Google Scholar 

  41. Schenk T, Bauer B, Steidle B, Marquardt C. Does training improve writer’s cramp? An evaluation of a behavioral treatment approach using kinematic analysis. J Hand Ther. 2004;17:349–63.

    Article  PubMed  Google Scholar 

  42. Espay AJ, Hung SW, Sanger TD, Moro E, Fox SH, Lang AE. A writing device improves writing in primary writing tremor. Neurology. 2005;64:1648–50.

    Article  CAS  PubMed  Google Scholar 

  43. Koller WC, Vetere-Overfield B. Usefulness of a writing aid in writer’s cramp. Neurology. 1989;39:149–50.

    Article  CAS  PubMed  Google Scholar 

  44. Ranawaya R, Lang A. Usefulness of a writing device in writer’s cramp. Neurology. 1991;41:1136–8.

    Article  CAS  PubMed  Google Scholar 

  45. Taş N, Karataş GK, Sepici V. Hand orthosis as a writing aid in writer’s cramp. Mov Disord. 2001;16:1185–9.

    Article  PubMed  Google Scholar 

  46. Jacobson E. Progressive relaxation. Chicago: University of Chicago Press; 1938.

    Google Scholar 

  47. Wieck A, Harrington R, Marks I, Marsden CD. Writer’s cramp: a controlled trial of habit reversal treatment. Br J Psychiatry. 1988;153:111–15.

    Article  CAS  PubMed  Google Scholar 

  48. Berg D, Naumann M, Elferich B, Reiners K. Botulinum toxin and occupational therapy in the treatment of writer’s cramp. Neurorehabilitation. 1999;12:169–76.

    Google Scholar 

  49. Baur B, Fürholzer W, Marquardt C, Hermsdörfer J. Auditory grip force feedback in the treatment of Writer’s Cramp. J Hand Ther. 2009;22:163–70.

    Article  PubMed  Google Scholar 

  50. O’Neill MA, Gwinn KA, Adler CH. Biofeedback for writer’s cramp. Am J Occup Ther. 1997;51:605–7.

    Article  PubMed  Google Scholar 

  51. Bindman E, Tibbetts RW. Writer’s Cramp—a rational approach to treatment? Br J Psychiatry. 1977;131:143–8.

    Article  CAS  PubMed  Google Scholar 

  52. Cottraux JA, Juenet C, Collet L. The treatment of writer’s cramp with multimodal behaviour therapy and biofeedback: a study of 15 cases. Br J Psychiatry. 1983;142:180–3.

    Article  CAS  PubMed  Google Scholar 

  53. Deepak KK, Behari M. Specific muscle EMG biofeedback for hand dystonia. Appl Psychophysiol Biofeedback. 1999;24:267–80.

    Article  CAS  PubMed  Google Scholar 

  54. Greenberg D. Writer’s cramp—a habit for reversal? J Behav Ther Exp Psychiatry. 1983;14:233–9.

    Article  CAS  PubMed  Google Scholar 

  55. Candia V, Rosset-Llobet J, Elbert T, Pascual-Leone A. Changing the brain through therapy for musicians’ hand dystonia. Ann N Y Acad Sci. 2005;1060:335–42.

    Article  PubMed  Google Scholar 

  56. Mai N, Marquardt C. Schreibtraining in der neurologischen Rehabilitation. In: EKN-Materialien für die Rehabilitation. Borgmann: Dortmund; 1999.

    Google Scholar 

  57. Marquardt C, Mai N. Treatment of writer’s cramp: kinematic measures as assessment tools for planning and evaluating handwriting training procedures. In: Fause C, Keuss P, Vinler G, editors. Advances in handwriting and drawing. Paris: Europia; 1994. p. 445–61.

    Google Scholar 

  58. Zeuner KE, Shill HA, Sohn YH, Molloy FM, Thornton BC, Dambrosia JM, Hallett M. Motor training as treatment in focal hand dystonia. Mov Disord. 2005;20:335–41.

    Article  PubMed  Google Scholar 

  59. Kimberley TJ, Borich MR, Schmidt RL, Carey JR, Gillick B. Focal hand dystonia: individualized intervention with repeated application of repetitive transcranial magnetic stimulation. Arch Phys Med Rehabil. 2015;96(4 Suppl):S122–8.

    Article  PubMed  Google Scholar 

  60. Rosset-Llobet J, Fàbregas i Molas S, Rosinés i Cubells D, Narberhaus Donner B, Montero i Homs J. Clinical analysis of musicians’ focal hand dystonia. Review of 86 cases. Neurologia. 2005;20:108–15.

    CAS  PubMed  Google Scholar 

  61. Berque P, Gray H, Harkness C, McFadyen A. A combination of constraint-induced therapy and motor control retraining in the treatment of focal hand dystonia in musicians. Med Probl Perform Art. 2010;25:149–61.

    PubMed  Google Scholar 

  62. Candia V, Elbert T, Altenmüller E, Rau H, Schäfer T, Taub E. Constraint-induced movement therapy for focal hand dystonia in musicians. Lancet. 1999;353(9146):42.

    Article  CAS  PubMed  Google Scholar 

  63. Candia V, Schäfer T, Taub E, Rau H, Altenmüller E, Rockstroh B, Elbert T. Sensory motor retuning: a behavioral treatment for focal hand dystonia of pianists and guitarists. Arch Phys Med Rehabil. 2002;83:1342–8.

    Article  PubMed  Google Scholar 

  64. Byl NN, Nagarajan SS, Merzenich MM, Roberts T, McKenzie A. Correlation of clinical neuromusculoskeletal and central somatosensory performance: variability in controls and patients with severe and mild focal hand dystonia. Neural Plast. 2002;9(3):177–203.

    Google Scholar 

  65. Byl NN, Nagajaran S, McKenzie AL. Effect of sensory discrimination training on structure and function in patients with focal hand dystonia: a case series. Arch Phys Med Rehabil. 2003;84(10):1505–14.

    Google Scholar 

  66. Byl NN, Archer ES, McKenzie A. Focal hand dystonia: effectiveness of a home program of fitness and learning-based sensorimotor and memory training. J Hand Ther. 2009;22:183–97.

    Article  PubMed  Google Scholar 

  67. Zeuner KE, Bara-Jimenez W, Noguchi PS, Goldstein SR, Dambrosia JM, Hallett M. Sensory training for patients with focal hand dystonia. Ann Neurol. 2002;51:593–8.

    Article  PubMed  Google Scholar 

  68. Sakai N. Slow-down exercise for the treatment of focal hand dystonia in pianists. Med Probl Perf Artists. 2006;21:25–8.

    Google Scholar 

  69. Chaná-Cuevas P, Kunstmann-Rioseco C, Rodríguez-Riquelme T. Guitarist’s cramp: management with sensory re-education. Rev Neurol. 2003;37:637–40.

    PubMed  Google Scholar 

  70. Jabusch HC, Zschucke D, Schmidt A, Schuele S, Altenmüller E. Focal dystonia in musicians: treatment strategies and long-term outcome in 144 patients. Mov Disord. 2005;20:1623–6.

    Article  PubMed  Google Scholar 

  71. Schuele SU, Lederman RJ. Long-term outcome of focal dystonia in instrumental musicians. Adv Neurol. 2004;94:261–6.

    PubMed  Google Scholar 

  72. Pesenti A, Barbieri S, Priori A. Limb immobilization for occupational dystonia: a possible alternative treatment for selected patients. Adv Neurol. 2004;94:247–54.

    PubMed  Google Scholar 

  73. Priori A, Pesenti A, Cappellari A, Scarlato G, Barbieri S. Limb immobilization for the treatment of focal occupational dystonia. Neurology. 2001;57:405–9.

    Article  CAS  PubMed  Google Scholar 

  74. Dressler D. Botulinumtoxin-Therapie: ein Ratgeber für Patienten. Hamburg: IAB; 2015.

    Google Scholar 

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Correspondence to Dirk Dressler M.D., Ph.D. .

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Dressler, D., Adib Saberi, F. (2017). Rehabilitation of Dystonia. In: Chien, H., Barsottini, O. (eds) Movement Disorders Rehabilitation. Springer, Cham. https://doi.org/10.1007/978-3-319-46062-8_4

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