Neurorehabilitation in dystonia: a holistic perspective
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NEUROLOGY AND PRECLINICAL NEUROLOGICAL STUDIES - REVIEW ARTICLE
Neurorehabilitation in dystonia: a holistic perspective Lynley V. Bradnam1 · Rebecca M. Meiring1 · Melani Boyce2,3 · Alana McCambridge2 Received: 9 August 2020 / Accepted: 9 October 2020 © The Author(s) 2020
Abstract Rehabilitation for isolated forms of dystonia, such as cervical or focal hand dystonia, is usually targeted towards the affected body part and focuses on sensorimotor control and motor retraining of affected muscles. Recent evidence, has revealed people who live with dystonia experience a range of functional and non-motor deficits that reduce engagement in daily activities and health-related quality of life, which should be addressed with therapeutic interventions. These findings support the need for a holistic approach to the rehabilitation of dystonia, where assessment and treatments involve non-motor signs and symptoms, and not just the dystonic body part. Most studies have investigated Cervical Dystonia, and in this population, it is evident there is reduced postural control and walking speed, high fear of falling and actual falls, visual compensation for the impaired neck posture, and a myriad of non-motor symptoms including pain, fatigue, sleep disorders and anxiety and depression. In other populations of dystonia, there is also emerging evidence of falls and reduced vision-related quality of life, along with the inability to participate in physical activity due to worsening of dystonic symptoms during or after exercise. A holistic approach to dystonia would support the management of a wide range of symptoms and signs, that if properly addressed could meaningfully reduce disability and improve quality of life in people living with dystonia. Keywords Dystonia · Holistic · Rehabilitation
Introduction Dystonia is a neurological movement disorder, where one or more body parts are affected by involuntary, sustained or intermittent muscle contractions causing abnormal postures, repetitive movements, tics or tremors (Albanese et al. 2013). Cervical dystonia (CD) is the most common form of idiopathic isolated dystonia affecting the head and neck (Dauer et al. 1998), with motor dysfunction and pain causing significant distress and disability (Pauw et al. 2017; Dool et al. 2016). The most common medical treatment for CD are regular botulinum toxin injections (BTX) (Ferreira et al. 2007), even though patients express limited satisfaction (Comella and Bhatia 2015). Rehabilitation by allied * Lynley V. Bradnam [email protected] 1
Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand
2
Graduate School of Health, Discipline of Physiotherapy, University of Technology, Sydney, NSW, Australia
3
Department of Physiotherapy, Westmead Hospital, Sydney, NSW, Australia
health professionals usually takes the form of exercises of the neck, to reduce activity in contracted muscles and enhance strength and function of their antagonist muscles (Boyce et al. 2013; Pauw et al. 2014), wi
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