Rehabilitation for Functional Dystonia: Cases and Review of the Literature.

BACKGROUND: Functional dystonia (FD) is a common subtype of functional movement disorder. FD can be readily diagnosed based on positive signs and is potentially treatable with rehabilitation. Despite this, clinical outcomes remain variable and a gold standard approach to treatment is lacking. CASES: Here we present four cases of axial and limb functional dystonia who were treated with integrated rehabilitation and improved. The therapy approach and clinical outcomes are described, including videos. LITERATURE REVIEW: A literature review evaluated the published treatment strategies for the treatment of functional dystonia. Out of 338 articles, 25 were eligible for review and included mainly case reports and case series. Most patients received more than one treatment modality. Non-invasive therapies, commonly physiotherapy and psychological approaches were mostly associated with positive outcomes. Multiple treatments commonly used in dystonia were used, including botulinum toxin injections, pharmacotherapy and surgery, leading to variable outcomes. CONCLUSION: Therapy should be personalized to the clinical presentation. In challenging cases, initiation of a multidisciplinary approach may provide benefit regardless of etiology. Pharmacotherapy should be used judiciously, and surgical therapy should be avoided.

An overview of rehabilitation approaches for focal hand dystonia in musicians: A scoping review.

OBJECTIVE: To provide a comprehensive overview of rehabilitation treatment strategies for focal hand dystonia (FHD) in musicians, examining their evolution and effectiveness. DATA SOURCES: A systematic search of five databases, PubMed, PEDro, Cochrane Library, Trip, and Google Scholar, to identify relevant articles on FHD rehabilitation. The last search was performed on 20 December 2023. METHODS: Inclusion criteria were applied to 190 initially identified articles, resulting in 17 articles for review. Exclusions were made for duplicates, irrelevant titles, abstracts, and non-rehabilitation interventions. RESULTS: Ten different rehabilitation approaches were identified over 20 years. While no definitive intervention protocol exists, a multimodal approach is commonly recommended. CONCLUSIONS: This scoping review underscores the diversity of rehabilitation strategies for FHD. It suggests the potential of multimodal approaches, emphasizing the need for further large-scale clinical efficacy studies.

Combinación de tres técnicas en el reentrenamiento de un músico con distonía focal: estudio de un caso / The use of three combined techniques in the retraining of a mucisian with focal dystonia: a case study

La distonía resulta de una co-contracción sostenida de músculos agonistas y antagonistas que puede causar torsión, movimientos involuntarios o posturas anormales que interfieren con el control voluntario de la mano, u otro grupo muscular, involucrados en una determinada acción; por ejemplo, tocar un instrumento, o escribir.El presente estudio descriptivo, de caso único, buscó probar la efectividad de un tratamiento que combinó tres técnicas (técnica del umbral, imaginería, y relajación por neurofeedback) en el reentrenamiento de un concertista profesional con distonía focal. Según evaluación por jueces, los resultados después de dos semanas de tratamiento, no fueron concluyentes. Sin embargo, el reporte experiencial del propio músico dio cuenta de una clara mejoría. Ante la carencia de un método efectivo para larehabilitación demúsicos con distonía focal, la relevancia del presente estudio consistió en identificar y combinar técnicas específicas que pueden contribuir a ese propósito. En estudios futuros, sería de interés probar el efecto del mismo tratamiento,pero más prolongado; o el efecto de la incorporación de las técnicas en sucesión progresiva, iniciando siempre con la relajación por neurofeedback.

Focal dystonia results from a sustained simultaneous co-contraction of agonists and antagonists muscle fibers which can cause twisting, involuntary movements or abnormal postures that interfere with voluntary control of the hand, arm, mouth, or other muscle groups involved in a given action; for example, playing an instrument, or hand writing. This descriptive, single case study, sought to explore the effectiveness of a treatment that combined three procedures: the threshold technique, imagery, and neurofeedback induced relaxation, in retraining of a professional cello player with focal dystonia. After two weeks of treatment, experts judged the results inconclusive; however, the report from the actual patient accounted for a note worthy recovery over time. In the absence of an effective method to rehabilitate musicians with focal dystonia, the relevance of this study resided on thepossibility of identifying and combining specific techniques that could be effective. Future studies might want to explore these same or different techniques, but perhaps for a longer period of time.

A new therapeutic proposal for writer's cramp: a case report / Nova proposta terapêutica para a câimbra do escrivão: relato de caso

CONTEXT: Writer's cramp is a kind of focal hand dystonia that appears when individuals are writing. Since pharmacological treatment has not shown the desired therapeutic response, a study on immobilization of the damaged musculature was performed on two individuals with writer's cramp, using splints with the objective of reducing the handwriting abnormalities. CASE REPORT: Two patients presenting writer's cramp who had previously undergone different therapies, including botulinum toxin, without an adequate response, participated in a body awareness program, followed by immobilization of the hand musculature damaged by dystonia, by means of splints, with handwriting training. At the end of the procedure, objective and subjective improvements in the motor pattern of writing could be observed. The immobilization of the dystonic musculature of the hand by means of splints and the motor training of handwriting helped to improve and consequently to reduce the dystonic component observed in the writer's cramp.

CONTEXTO: A câimbra do escrivão é um tipo de distonia focal da mão que aparece quando a pessoa escreve. Como o tratamento farmacológico não tem mostrado a resposta terapêutica almejada, um estudo sobre a imobilização da musculatura comprometida foi feito em dois indivíduos com câimbra do escrivão, utilizando órteses com o objetivo de reduzir as alterações da escrita. RELATO DE CASO: Dois pacientes apresentando câimbra do escrivão que haviam sido submetidos previamente a terapêuticas, inclusive toxina botulínica, sem resposta adequada, participaram de um programa de consciência corporal, seguido de imobilização por órteses da musculatura da mão comprometida pela distonia, com treinamento da escrita. Ao término, evidenciaram melhora objetiva e subjetiva no padrão motor da escrita. A imobilização por órteses da musculatura distônica da mão e o treinamento motor da escrita favorecem a melhora e, consequentemente, a redução do componente distônico observado na câimbra do escrivão.