Massage Therapy for Dystonia: a Case Report
Abstract and Figures
Background: Dystonia is a neurological disorder, characterized by involuntary muscle spasms and tremors, resulting in abnormal movements and posture. Symptoms include pain, spasms, tremors, and dyskinesia—a difficulty in performing voluntary muscular movements. Conventional treatments include medication, botulism injections, and surgical intervention. Many dystonia patients seek complementary and alternative medicine (CAM) therapies, such as massage, but these treatments are not well documented. This clinical case study documents massage treatment for dystonia for a specific individual. Purpose: To examine the effects of massage therapy on pain, spasms, and dyskinesia in activities of daily living (ADL), in a patient diagnosed with dystonia as an adult, following trauma. Methods: A student massage therapist administered 5 massage treatments over a six-week period to a 51-year-old female patient diagnosed with dystonia. The patient presented with symptoms of pain, spasms, tremors, and dyskinesia in ADL. Techniques applied included Swedish massage and hydrotherapy to decrease pain and spasms, and myofascial release and stretching, to decrease dyskinesia. Treatments aimed to increase overall relaxation. Remedial exercise was given to practice smoother movement patterns. Pre- and postnumeric rating scales (NRS) for pain were evaluated each session. Frequency of night pain and spasms, the Modified Bradykinesia Rating Scale (MBRS), the Timed Up and Go (TUG) test, the Functional Rating Index (FRI) and the Modified Gait Efficacy Scale (MGES) were measured at the start and end of the study. Results: Posttreatment pain intensity generally remained the same or decreased. Positive outcomes were exhibited in the frequency of night pain and spasms, TUG, MBRS, and FRI test scores. The MGES score was negatively affected. Conclusion: The results suggest massage therapy may temporarily decrease pain intensity, pain and spasm frequency, and dyskinesia in ADL, associated with dystonia.
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33
International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
Background: Dystonia is a neurological
disorder, characterized by involuntary
muscle spasms and tremors, resulting
in abnormal movements and posture.
Symptoms include pain, spasms, tremors,
and dyskinesia—a difculty in perform-
ing voluntary muscular movements.
Conventional treatments include medi-
cation, botulism injections, and surgical
intervention. Many dystonia patients seek
complementary and alternative medi-
cine (CAM) therapies, such as massage,
but these treatments are not well docu-
mented. This clinical case study docu-
ments massage treatment for dystonia
for a specic individual.
Purpose: To examine the effects of mas-
sage therapy on pain, spasms, and dyski-
nesia in activities of daily living (ADL), in
a patient diagnosed with dystonia as an
adult, following trauma.
Methods: A student massage therapist
administered 5 massage treatments over
a six-week period to a 51-year-old female
patient diagnosed with dystonia. The pa-
tient presented with symptoms of pain,
spasms, tremors, and dyskinesia in ADL.
Techniques applied included Swedish
massage and hydrotherapy to decrease
pain and spasms, and myofascial release
and stretching, to decrease dyskinesia.
Treatments aimed to increase overall re-
laxation. Remedial exercise was given to
practice smoother movement patterns.
Pre- and postnumeric rating scales (NRS)
for pain were evaluated each session.
Frequency of night pain and spasms,
the Modied Bradykinesia Rating Scale
(MBRS), the Timed Up and Go (TUG) test,
the Functional Rating Index (FRI) and the
Modied Gait Efcacy Scale (MGES) were
measured at the start and end of the study.
Results: Posttreatment pain inten-
sity generally remained the same or de-
creased. Positive outcomes were exhibited
in the frequency of night pain and spasms,
TUG, MBRS, and FRI test scores. The MGES
score was negatively affected.
Conclusion: The results suggest massage
therapy may temporarily decrease pain
intensity, pain and spasm frequency, and
dyskinesia in ADL, associated with dystonia.
KEY WORDS: neurologic disorders; move-
ment disorders; dystonia; massage; pain
INTRODUCTION
Dystonia is a neurological condition,
characterized by sustained involuntary
muscle spasms, tremors, or excessive
muscle activation, resulting in twisting,
writhing movements and abnormal pos-
ture.(1-4) Dystonic patterns vary in severity,
depending on the activity or posture, and
may occur at rest.(1,2) Typically considered
a movement disorder, growing evidence
indicates abnormalities in sensory and
perceptual functions, neuropsychiatric
and cognitive issues, and sleep.(2,3) Reliable
screening is currently unavailable for large
populations, and dystonia is likely under-
diagnosed or misdiagnosed.(5)
There are over 50 types of dystonia and
associated syndromes, with new emerging
(1,6) For ex -
ample, primary dystonia is where dystonia
is the only clinical sign.(1,3,6) Late-onset oc-
curs after 30 years of age.(1,3) Focal dystonia
affects single, or multiple, non-contiguous
body regions.(1,3)
Current research regarding the etiology
of dystonia is inconclusive.(1-3) Causes of
dystonia may be multifactorial, and will
vary widely, depending on the type.(1,3,5)
Dystonia may be a result of brain trau-
ma,(1-3) or peripheral trauma.(7)
The symptoms of dystonia may cause
of life.(1) Decreased functional ability can
(1,8)
PRACTICE
Massage Therapy for Dystonia:
a Case Report
Michelle Lipnicki, BSc, RMT
Department of Allied Health and Human Performance, MacEwan University, St. Albert, AB, Canada
34
International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
unspecified classification of dystonia.
Symptoms began 19 years ago following
a rock climbing accident, where she fell
on her feet from a height of eight metres.
She felt immediate pain in her lower body,
sustaining numerous musculoskeletal in-
juries. X-rays of her feet showed multiple
fractures; no other tests were sought at
the time. She claimed neurological symp-
toms began after the accident, including
pain in the thoracolumbar spine radiat-
ing to the upper and lower body, muscle
spasms and tremors in the hands and feet,
physiotherapy, chiropractic manipulations,
massage therapy, and exercise rehabilita-
tion. The patient noted these modalities
would often elicit pain and spasms dur-
ing application. Pain, spasms, and jerky,
unstable movements persisted, following
recovery from the injuries. In 2003, her
neurologist diagnosed dystonia. Baclofen,
a medication commonly used for certain
types of dystonia,(1) was prescribed in 2006
and ingested for 18 months. Over the past
year, the patient managed her symptoms
with weekly acupuncture treatments, and
light exercise three times a week.
Past history included a head injury sus-
tained in a motor vehicle accident in 1982,
resulting in occasional tingling in the head
or vision changes.
Her major complaint was pain and ten-
sion in the posterior thoracolumbar region,
causing radiating pain in the shoulders,
neck, hips, and thighs, and spasms in
her hands and feet. The pain and spasms
would cause occasional tremors in her
hands and feet, affecting her ability to type,
sit, stand, or walk for long periods. Her main
goals for treatment were to decrease pain,
Clinical Findings
The numeric rating scales (NRS) was
used to evaluate pain intensity, as previ-
ous research supported the validity of this
scale.(13)
radiating pain in the posterior thoracolum-
bar region was usually 3, at least 1, and at
worst 7. Sitting, bending, lifting, climbing
stairs, overexertion, and repetitive hand
movements aggravated the pain. Rest, ly-
ing down, or time, eased the pain. Lower
body pain was reportedly worse in the left
hip but lessened when walking, and woke
symptoms included occasional headaches
Typical symptoms include abnormal pos-
ture, pain, spasms, tremors, and dyskinesia,
-
lar movements.(1,4,9) Planning of voluntary
movements may also be affected.(2) Com-
monly affected are the neck or eyes, but
other areas may be affected, such as the
trunk, limbs, and hands.(7)
There is currently no known cure for
dystonia, and treatment is aimed at restor-
ing function and managing symptoms.(3)
Conventional treatments include prescrip-
tion medication, botulism injection, and
surgical intervention.(1,3,4) Physical therapy,
rehabilitation, and ergonomic changes
have also been used.(3,4,8)
-
manage symptoms.(4) Fifty to eighty per
cent of participants in various studies used
massage, acupuncture, relaxation, home-
opathy, chiropractic adjustments, and
breathing therapy, often in conjunction
with conventional therapies.(4,9-11) Previous
research showed dystonia patients could
(4)
The effects of massage on dystonia are
not well documented; a literature review
displayed a significant lack of research
in peer-reviewed publications. One peri-
odical article was found, relating the use of
massage therapy on focal hand dystonia,
documented.(12) Some types, such as focal
hand dystonia and cervical dystonia, have
(8,11) however,
treatment mainly involved physical thera-
py rather than massage.(8) In addition, as
there are numerous types of dystonia that
respond differently to various treatments,
this information may not be applicable to
(3,5,9)
This report aims to bring additional in-
sight into the symptom management of
with dystonia patients, it is important to
discover effective therapeutic massage
treatments for dystonia. The objective of
this case study is to observe the effects of
massage therapy on pain, spasms, and dys-
METHODS
Participant
-
dent presented to the clinic with an
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International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
-
(14)
has been proven useful in other dystonia
research.(18,19)
Rating Scale (MBRS) is a reliable measure
highly correlating with kinematic vari-
ables.(20)
for assessing Parkinson's disease (PD), dys-
tonia also affects kinematic function;(18,19)
therefore, the MBRS was used in this case
(20) To simplify
assessment measures, only pronation-
supination of both hands was evaluated.
Therapeutic Intervention
2,200-hour diploma program conducted
the study in 2017. The patient attended
the student massage clinic in Edmonton,
not diagnosed, treatment design was
based on the patient's goals for treatment,
symptoms, assessment, and health history.
Dystonia often presents with similar clinical
manifestations as PD.(1,6) Therapeutic treat -
ments suggested for tremors and spastic-
ity, were therefore deemed appropriate for
treatment in this case.(21)
Contraindications
to promote relaxation for the patient.(21) Ver y
like stretching or movement therapy, may
cause stimulatory effects or activate the
(21,22) Deep pressure may over-
stimulate the tissue and increase muscle
tension and rigidity.(22) Therefore, tech-
rhythmical, continuous manner to prevent
eliciting spasm during treatment.(21)
Treatment Plan
Following the initial assessment, 5 treat-
ments were administered on the same day
and time each week. Each session began
with a discussion to involve the patient in
the treatment process, and informed con-
during the study period could affect the ac-
curacy of the results; the patient agreed to
discontinue treatments during this period.
Fifty min were allotted for each treatment.
in the posterior cranium and difficulty
breathing during painful episodes.
was performed, including observation of
posture and gait, as well as orthopaedic
tests.(14) Postural analysis indicated slight
hyperkyphosis with trunk rotation to the
right. The right shoulder presented with
gait of uncoordinated, unsteady move-
ment was noted, with slight hip drop and
unstable, jerky movements of the lower
-
her thighs; there was exaggerated forward
movement was slow and jerky.
Assessment Measures
is essential, as it will affect outcomes
and posttreatment comparison.(3) The
-
Dystonia Rating Scale are standards for
evaluating dystonia.(1,15) Due to the highly
-
ment of an expert observer for these as-
sessment tools,(5) other methods were
selected for this case study due to limita-
measures were chosen based on the pa-
tient's symptoms and desired outcomes.
Pre- and posttreatment pain scales were
assessed using the NRS at each treatment
session.(13)
areas of pain, no separate measure was
taken. The patient was asked to keep a
daily record of overnight pain and spasm
following measures were evaluated once
-
were considered. Due to its ease in ad-
ministration and ability to assess gait is-
used.(16) The test protocols are outlined
(16) -
tively evaluated balance and mobility in
older age populations and patients with
neuropathy.(16,17) -
naires were administered. The Functional
Rating Index (FRI) scores how pain and
back problems have affected a patient's
B).(14) -
jor complaint, relevant feedback could
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International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
-
mote relaxation. Hydrotherapy, stretching,
movement therapy, and joint mobilization
Home-care was given to increase re-
laxation and facilitate functional ability
-
tion (ROM), and balance.(21) The patient
was instructed to practice diaphragmatic
breathing at rest, daily, either in a seated
Table 1 details the plan developed for the
patient; the main focus was relaxation-
based, with an intention to decrease pain
and spasticity.(21,22,24)
-
sessments were made; therefore, only 30
predetermined plan was created to obtain
reliable and consistent results; however,
modifications were made for the final
two sessions, to adjust for patient con-
cerns. The patient complained that certain
-
1. Treatment Plan
Position Technique Application Outcome
Prone Rocking and Stroking
2 min
Induce relaxation(21,22)
Hydrotherapy
15 min
Decrease pain and
hypertonicity(23)
Swedish
10 min
Longitudinal stroking, palmar kneading, picking up,
and wringing on posterior hip, thigh, calf and foot;
origin and insertion frictions and movement therapy
(passive ROM) at hip and knee
Increase relaxation;
decrease pain,
spasticity and
hypertonicity; increase
mobility(21,22)
Neuromuscular
4 min
hamstring muscles
Decrease pain referral
patterns(21)
Passive Stretching
2 min
Increase muscle
length and decrease
hypertonicity(24)
Myofascial
2 min
Remove moist heat; skin rolling across back Relax and soften
tissues(22)
Swedish
10 min
Longitudinal stroking, palmar kneading, picking up,
and wringing on posterior thoracolumbar region;
muscle approximation along erectors
Increase relaxation;
decrease pain and
hypertonicity(21,22)
Supine Swedish
8 min
Longitudinal stroking, palmar kneading, picking up,
and wringing on anterior hip, thigh and lower leg;
passive ROM of hip
Increase relaxation;
decrease pain and
hypertonicity(21,22)
Joint Mobilizations
3 min
Decrease pain and
spasm(24)
Passive Stretching
1 min
Static hold of gluteal stretch; movement therapy
Increase muscle
length and ROM(24)
MLD
5 min
Head, neck, and anterior upper chest Increase general
relaxation and prevent
headaches(25)
Myofascial
1 min
Suboccipital release Relax and soften
tissues(22)
Rocking and Stroking
1 min
Induce general
relaxation and
encourage whole
(21)
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International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
posttreatment data collection. Pain in-
tensity was not reportedly high for most
pretreatment assessments; changes in
was reported in Week Four, as the patient
stated a higher pretreatment value relative
to other weeks. Comparing pretreatment
pain and spasm experienced overnight
No marked changes were noted in pos-
tural assessment, except both shoulders
-
ent; however, smoother movement was
observed in the lower body. When per -
hand support on her thighs, but move-
ment was smoother and faster relative to
the initial assessment.
Improved outcomes were displayed
in time to execute the task was shown.
The MBRS test score displayed improved
results. For both hands, scores for rhythm
were improved. Speed was also improved
test score displayed an improved result.
-
ing, were the parameters most notably
activities at the end of the study period.
walking up and down stairs without a rail-
ing. During the pretreatment discussions
of the last three sessions, the patient re-
ported increased tension and soreness in
the lower legs and feet from changes in
walking conditions caused by the weather
(slippery ground due to ice and snow), as
the study period progressed.
or supine position, and to perform a trunk
(21)
RESULTS
Table 3 provides a summary of the
results. Intensity of pain in the poste-
rior thoracolumbar region generally re-
mained the same or decreased, in pre- and
Week Position Techniques
1Prone Rocking and Stroking 2 min
Hydrotherapy 15 min
Swedish 10 min
Neuromuscular 4 min
Passive Stretching 2 min
Myofascial 2 min
Swedish 10 min
2&3 Prone Rocking and Stroking 2 min
Hydrotherapy 15 min
Swedish 10 min
Neuromuscular 4 min
Passive Stretching 2 min
Myofascial 2 min
Swedish 10 min
Supine Swedish 8 min
Joint Mobilizations 3 min
Passive Stretching 1 min
MLD 5 min
Myofascial 1 min
Rocking and Stroking 1 min
4&5 Prone Rocking and Stroking 2 min
Swedish 12 min
Neuromuscular 4 min
Myofascial 2 min
Swedish 10 min
Supine Swedish 10 min
MLD 5 min
Myofascial 2 min
Rocking and Stroking 2 min
. Summary of Results
Week 1 Week 5
Pre-treatment Pain Scale (0-10) 3 3
(nights/week)
7 3
8.68 7
Scale (0-24)
9 4
Functional Rating Index (0-40) 18 14
(0-100)
10 19
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International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
In addition, after the third treatment, the
patient noticed increased pain, spasms, or
tremors, on nights following treatments or
scale did not decrease during the study
patient stated she felt, "amazed massage
could provide relaxation because in the
past it often worsened the symptoms."
The patient did not manage to provide
and spasm experienced overnight for the
was only compliant with prescribed home
of treatment. In addition, she occasionally
applied acupuncture to herself to ease pain
during the week.
DISCUSSION
The results of this study demonstrate
some positive, short-term effects on symp-
toms of dystonia through the application
of massage therapy. Posttreatment pain
dyskinesia were improved during the study
period, meeting the patient's goals for
treatment. The patient's altered gait dur-
ing changing weather conditions during
the study period may have contributed to
the MBRS, as well as smoother execution
showed a decrease in dyskinesia. Patients
with dystonia could possibly benefit
from massage treatment in a clinical set-
ting.(8,11,12)
-
ings that massage can perhaps reduce
dystonia symptoms,(12) but note this source
is not peer-reviewed. There are currently no
reports on dystonia affecting two or more
body regions,(9) and cases of peripheral
trauma preceding the onset of dystonia
are relatively rare.(7) Dystonia occurring
in the lower limb is also uncommon and
less documented, presenting a challenge
case.(26)
The importance of this case report is that
little research has been done observing
the effects of massage therapy on dystonia
affecting more than one body region, fol-
lowing peripheral trauma, or in the lower
limb.(7,9,26) It demonstrates how massage
therapy can be effective in a clinical setting.
There are several limitations of this case
complex.(1,3,6) Knowledge of the patient's
exact type of dystonia would have been
-
tion could have been more accurately
addressed with increased specificity of
research, evaluation of progress, and treat-
ment given.(3,5) Inclusion of more stringent
methods of evaluation, such as the FMRS,
would have increased the validity of results
obtained. Furthermore, reliable and con-
sistent feedback could not be obtained
with hydrotherapy and remedial exercise,
conclusions could not be drawn regarding
-
over, a longer period of observation may
have yielded more reliable results.
Massage therapy may be a useful tool in
symptom management for patients with
dystonia.(8,11,12) This case study demon-
strates massage can have a positive effect
been conducted on this topic, this report in-
tends to inspire more research on massage
therapy and its effect on dystonia affecting
more than one body region, following pe-
ripheral trauma, or in the lower limb.
Further research is recommended to
determine how effective massage therapy
safe treatments.(4,9-11) More general prac-
patients are using these alternatives in
conjunction with conventional thera-
pies.(4,10,11) Recent research displays a con-
nection between sensory modalities and
the motor systems affected by dystonia,
implicating a need to investigate tactile
inputs such as massage and its effects
with this disorder.(2) For future research
initiatives, randomized controlled trials and
larger sample sizes will provide more reli-
able results.(2,3,9,10)
spectrum of dystonia types, more forms of
the disorder need to be studied in clinical
trials. Longer evaluation periods, to observe
long-term effects, will also be informative.
will compare the efficacy of each, and
aid in determining appropriate massage
In this manner, individually tailored treat-
ment plans may be designed for patients
with dystonia.(10)
39
International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
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lization and perceived effectiveness of comple-
mentary and alternative medicine in patients with
dystonia. Mov Disord. 2004;19(2):158–161.
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ed. St. Louis, MO: Elsevier Saunders; 2014.
Mink JW, Post B, et al. Dystonia rating scales:
Mov Disord.
2013;28(7):874–883.
mobility assessment for ruling-out the peripheral
neuropathy of the lower limbs in older adults. Gait
Posture. 2016;50:109–115.
17. Jernigan SD, Pohl, PS, Mahnken JD, Kluding PM.
Diagnostic accuracy of fall risk assessment tools in
people with diabetic peripheral neuropathy. Phys
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K, Broussolle E, et al. Dopa-responsive dystonia and
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effects. Brain Dev. 2015;37(6):643–650.
19. Mirlicourtois S, Bensoussan L, Viton JM, Collado H,
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ACKNOWLEDGMENTS
The author would like to extend thanks
to the staff and faculty of the Massage
for their guidance and support.
CONFLICT OF INTEREST NOTIFICATION
The author declares there are no con-
COPYRIGHT
Published under the CreativeCommons
.
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Corresponding author: Michelle Lipnicki,
E-mail: michelle.lipnicki@gmail.com
-
involvement in adult-onset primary dystonia:
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International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
timing. Stop timing after the patient has
sat back down.
Instructions to the Patient
On the word "go", stand up from the
normal pace, turn, walk back to the chair
at your normal pace, and sit down again.
APPENDICES
protolcols.
Directions
Patients wear their regular footwear. Be-
gin with the patient sitting back in a stan-
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International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
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International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
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International Journal of Therapeutic Massage and Bodywork—Volume 13, Number 2, June 2020
Trunk rotation exercise.
ResearchGate has not been able to resolve any citations for this publication.
Background Primary dystonia is a chronic neurological movement disorder that causes abnormal muscle movements. Pain and emotional distress may accompany these physical symptoms. Behavioural interventions are used to help people with long term conditions improve their quality of life. Little is known about behavioural interventions applied to Dystonia. We report a systematic review of studies reporting current evidence of behavioural interventions for people with primary dystonia. Methods We did systematic searches of Medline, PsycINFO, AHMED and CINAHL. We assessed the methodological quality of included studies using a risk of bias tool. Any disagreements were resolved by liaising with an independent rater. Physiological outcomes such as dystonia severity and psychological outcomes such as sleep and depression were selected on the basis that primary dystonia causes motor and non-motor symptoms. No time limit was placed on the searches. A narrative synthesis of the results is presented. Results Of 1798 titles and abstracts screened, 14 full articles were retrieved and inclusion and exclusion criteria applied. Of these a final nine were eligible for the review (N = 73). Only two were Randomised Controlled Trials (RCTs). Using the Movement Disorders Society (MDS) dystonia classification, that was published after this work started, all of the included studies were of idiopathic adult onset focal dystonia without associated features. These included: blepharospasm (eye dystonia) (N = 1), cervical dystonia (neck dystonia) (N = 2), writer's cramp (hand dystonia) (N = 3) and the yips (N = 3). No studies reported on dystonia that affects two or more body regions. Studies reported good adherence and response rates to treatment. Physiological and psychological improvements were noted in all studies at weekly, monthly and yearly follow-ups. Caution should be taken when interpreting the results because of the scarcity of RCTs identified, use of small sample sizes, and inappropriate statistical methods. Conclusion We identified few studies; mainly of poor methodological quality that all studied a focal dystonia. It is not possible to draw firm conclusions. Nevertheless, the data suggests that a combined behavioural therapy approach including relaxation practice for people with idiopathic adult onset focal dystonia merits further investigation.
The peripheral neuropathy of the lower limbs (PNLL) is an important cause of balance and mobility impairment in older adults. The nerve conduction study (NCS) is the gold standard for PNLL diagnosis. Aim of this work is to establish the sensitivity (Sn) and the specificity (Sp) of the balance and mobility examination for the PNLL in older adults. This study consecutively recruited 72 participants (>65years) who accessed to the clinical neurophysiology outpatient clinic for suspected PNLL. Participants were given the NCS and four clinical tests. Mobility was evaluated by the Timed Up and Go (TUG) test, the Performance Oriented Mobility Assessment (POMA) and the de Morton Mobility Index (DEMMI). In addition the Clinical Evaluation of Static Upright Stance (CELSIUS) scale was developed for a selective evaluation of static balance. Based on the NCS, 36% of participants had PNLL. The CELSIUS scale (cutoff: 19.5/24), the TUG test (cutoff: 9.6s) and the DEMMI scale (cutoff: 17.5/19) have high Sn (0.92÷0.96), but low Sp (0.28÷0.43) for the PNLL in the older adult. POMA scale (cutoff: 14.5/16) has low Sn (0.73), but acceptable Sp (0.85). In addition, CELSIUS, DEMMI and TUG negative likelihood ratios are 0.13, 0.17 and 0.12, respectively. Balance and mobility examination have high sensitivity for PNLL. CELSIUS score>19/24, DEMMI score>17/19 or TUG time≤9.6s substantially reduce PNLL likelihood. These clinical measures are thus recommended for ruling-out PNLL in the older adult.
- M. Sinclair
This text offers a modern approach to hydrotherapythe use of water, ice, steam, and hot and cold temperatures to improve or maintain healthas performed by massage therapists. Authored by an experienced massage therapist, this book presents clear, uncomplicated explanations of how hydrotherapy affects the body, and then demonstrates a wide variety of hydrotherapy treatments. The book suggests how massage therapists may use hydrotherapy treatments before and during massage sessions, or give these treatments to clients to do between sessions for faster and better results. The author presents real-life examples and case studies obtained through interviews with massage therapists, athletic trainers, physical therapists, naturopathic doctors, aquatic therapists, and medical doctors treating patients in a medical hydrotherapy setting. © 2008 Lippincott Williams & Wilkins, a Wolters Kluwer business. All rights reserved.
- Svenja Happe
- Andreas Peikert
- Rudolf Siegert
- Stefan Evers
This study aimed at examining the efficacy of lymphatic drainage (LD) and traditional massage (TM) in the prophylactic treatment of migraine using controlled prospective randomized clinical trial of 64 patients (57 women, 45 ± 10 years) with migraine with and without aura. Patients were randomized into three groups: LD (n = 21); TM (n = 21); waiting group (WG, n = 22). After a 4-week-baseline, a treatment period of 8 weeks was applied followed by a 4-week observation period. The patients filled in a headache diary continuously; every 4 weeks they filled in the German version of the CES-D and the German version of the Headache Disability Inventory. The main outcome measure was migraine frequency per month. At the end of the observation period, the number of migraine attacks and days decreased in the LD group by 1.8 and 3.1, respectively, in the TM group by 1.3 and 2.4, and in the WG by 0.4 and 0.2, respectively. The differences between LD and WG were significant (p = 0.006 and p = 0.015, respectively) as well as the differences between TM und WG (p = 0.042 and p = 0.016, respectively). There was a significant decrease in the amount of analgesic intake in the LD group compared to the two other groups (p = 0.004). TM and LD resulted in a reduction of migraine attack frequency. The analgesic intake only decreased significantly during LD intervention. Useful effects were identified for LD and TM as compared to WG for the prophylaxis of migraine. LD was more efficacious in some parameters than TM.
Traditional definitions of focal dystonia point to its motor component, mainly affecting planning and execution of voluntary movements. However, focal dystonia is tightly linked also to sensory dysfunction. Accurate motor control requires an optimal processing of afferent inputs from different sensory systems, in particular visual and somatosensory (e.g., touch and proprioception). Several experimental studies indicate that sensory-motor integration -the process through which sensory information is used to plan, execute, and monitor movements- is impaired in focal dystonia. The neural degenerations associated with these alterations affect not only the basal ganglia-thalamic-frontal cortex loop, but also the parietal cortex and cerebellum. The present review outlines the experimental studies describing impaired sensory-motor integration in focal dystonia, establishes their relationship with changes in specific neural mechanisms, and provides new insight towards the implementation of novel intervention protocols. Based on the reviewed state-of-the-art evidence, the theoretical framework summarized in the present article will not only result in a better understanding of the pathophysiology of dystonia, but it will also lead to the development of new rehabilitation strategies. Copyright © 2015. Published by Elsevier Ltd.
Introduction Patients suffering Dopa-Responsive Dystonia present dystonia, abnormal postural balance and gait impairment. Treatment with levodopa typically improves these three symptoms. The present study provides an extensive analysis of gait and posture in a patient with Dopa-Responsive Dystonia, prior to and during levodopa therapy. Method The patient was assessed with the Unified Dystonia Rating Scale, underwent motion analysis with an optoelectronic system and postural analysis with force plates. Results This study provides a detailed quantification of gait parameters in a Dopa-Responsive Dystonia patient. Prior to treatment, mean walking speed was severely reduced, gait cadence and step length were decreased and stride width was increased. Right lower limb and pelvis showed kinematic defects, trunk and Centre of Mass were backwards. During levodopa therapy, the walking speed was doubled, gait cadence and step length were increased and stride width was reduced. Nearly all kinematic parameters of lower limbs were significantly improved. The patient's Centre of Mass during gait and Centre of pressure in static position both shifted forward. Conclusion Levodopa dramatically decreased dystonia and improved spatio-temporal, kinematic and posture parameters. Our main pathophysiological hypothesis is that trunk tilt and its consequences on the Centre of Mass position have a pivotal influence on gait and balance, explaining both the initial impairments and the therapeutic effects. Gait analysis proves to be an effective tool to understand the pathophysiology of this patient, the therapeutic effects and mild residual gait defects in order to plan further rehabilitation strategy for this DRD patient. We propose that it will also prove to be useful for the exploration of other dystonic patients.
Background Patients with cervical dystonia (CD) frequently express interest in complementary and alternative medicine (CAM) methods. We assessed the frequency of CAM utilization (including physiotherapy), evaluated perceived effectiveness and identified predictors for the treatment choice. Methods Standardized questionnaires of 266 patients, recruited from two diverse sources, were analyzed. Group 1 (n = 101) comprised patients recruited from 2 centers specialized in treatment of CD while group 2 (n = 165) consisted of volunteers of the German national patient advocacy group. Results At least one CAM-classified therapy was used by 81%. Those CAM therapies which were used most frequently (massages, acupuncture, chiropraxy) were not judged as effective or even had negative effects on dystonic symptoms. Special physiotherapy and psychotherapy were evaluated as most beneficial. Most patients made use of CAM in addition to botulinum toxin (BTX) injections, in particular when they were less satisfied with BTX treatment or had adverse effects. Other predictors of CAM-treatment choice were a long duration of CD, male sex, psychological stress and group 2 membership. Conclusions Some treatment combinations (conventional treatment and special physiotherapy or psychotherapy) may hold promise for further evaluation, especially when long-term monotherapy with BTX is no longer satisfactory.
The clinical evaluation of a patient with dystonia is a stepwise process, beginning with classification of the phenomenology of the movement disorder(s), then formulation of the dystonia syndrome, which, in turn, leads to a targeted etiological differential diagnosis. In recent years, there have been significant advances in our understanding of the etiological basis of dystonia, aided especially by discoveries in imaging and genetics. In this review, we provide an update on the assessment of a patient with dystonia, including the phenomenology of dystonia and highlighting how to integrate clinical, imaging, blood, and neurophysiological investigations in order to formulate a dystonia syndrome. Evolving or emerging dystonia syndromes are reviewed, and potential etiologies of these as well as established dystonia syndromes listed to guide diagnostic testing. © 2013 Movement Disorder Society.
Many rating scales have been applied to the evaluation of dystonia, but only few have been assessed for clinimetric properties. The Movement Disorders Society commissioned this task force to critique existing dystonia rating scales and place them in the clinical and clinimetric context. A systematic literature review was conducted to identify rating scales that have either been validated or used in dystonia. Thirty-six potential scales were identified. Eight were excluded because they did not meet review criteria, leaving 28 scales that were critiqued and rated by the task force. Seven scales were found to meet criteria to be "recommended": the Blepharospasm Disability Index is recommended for rating blepharospasm; the Cervical Dystonia Impact Scale and the Toronto Western Spasmodic Torticollis Rating Scale for rating cervical dystonia; the Craniocervical Dystonia Questionnaire for blepharospasm and cervical dystonia; the Voice Handicap Index (VHI) and the Vocal Performance Questionnaire (VPQ) for laryngeal dystonia; and the Fahn-Marsden Dystonia Rating Scale for rating generalized dystonia. Two "recommended" scales (VHI and VPQ) are generic scales validated on few patients with laryngeal dystonia, whereas the others are disease-specific scales. Twelve scales met criteria for "suggested" and 7 scales met criteria for "listed." All the scales are individually reviewed in the online information. The task force recommends 5 specific dystonia scales and suggests to further validate 2 recommended generic voice-disorder scales in dystonia. Existing scales for oromandibular, arm, and task-specific dystonia should be refined and fully assessed. Scales should be developed for body regions for which no scales are available, such as lower limbs and trunk. © 2013 Movement Disorder Society.
Background Diabetic peripheral neuropathy affects nearly half of individuals with diabetes and leads to increased fall risk. Evidence addressing fall risk assessment for these individuals is lacking.Objective The purpose of this study was to identify which of 4 functional mobility fall risk assessment tools best discriminates, in people with diabetic peripheral neuropathy, between recurrent "fallers" and those who are not recurrent fallers.DesignA cross-sectional study was conducted.SettingThe study was conducted in a medical research university setting.ParticipantsThe participants were a convenience sample of 36 individuals between 40 and 65 years of age with diabetic peripheral neuropathy.MeasurementsFall history was assessed retrospectively and was the criterion standard. Fall risk was assessed using the Functional Reach Test, the Timed "Up & Go" Test, the Berg Balance Scale, and the Dynamic Gait Index. Sensitivity, specificity, positive and negative likelihood ratios, and overall diagnostic accuracy were calculated for each fall risk assessment tool. Receiver operating characteristic curves were used to estimate modified cutoff scores for each fall risk assessment tool; indexes then were recalculated. RESULTS: /b>Ten of the 36 participants were classified as recurrent fallers. When traditional cutoff scores were used, the Dynamic Gait Index and Functional Reach Test demonstrated the highest sensitivity at only 30%; the Dynamic Gait Index also demonstrated the highest overall diagnostic accuracy. When modified cutoff scores were used, all tools demonstrated improved sensitivity (80% or 90%). Overall diagnostic accuracy improved for all tests except the Functional Reach Test; the Timed "Up & Go" Test demonstrated the highest diagnostic accuracy at 88.9%.LimitationsThe small sample size and retrospective fall history assessment were limitations of the study. CONCLUSIONS:/b>Modified cutoff scores improved diagnostic accuracy for 3 of 4 fall risk assessment tools when testing people with diabetic peripheral neuropathy.
Source: https://www.researchgate.net/publication/342131768_Massage_Therapy_for_Dystonia_a_Case_Report
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