The effect of physical therapy in the treatment of patients with cervical dystonia with or without concomitant use of botulinum toxin

Abstract

Background/Aim. Botulinum toxin is a basic, recommended method of treatment in controlling cervical dystonia (CD). Physical therapy has limited effect due to the nature of the disease that is a result of a disorder in structures and relationships of the basal ganglia. The aim of this study was to analyze the effect of physical therapy applied as monotherapy, or with parallel application of botulinum toxin in patients with CD. Methods. Randomized controlled clinical pilot study included 14 patients diagnosed with idiopathic CD. All patients were initially assessed by using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS) and Torticollis Rating Scale (Tsui scale). In the control group, composed of 5 patients, the treatment included only physical therapy. The experimental group (9 patients) was first given botulinum toxin, and physical therapy was applied after five days. Physical therapy was conducted five times a week in the period of two weeks at the Clinic. Patients of both groups were instructed to continue with the physical therapy at home. The effects of treatment

The effectiveness of physiotherapy for patients with isolated cervical dystonia: an updated systematic review and meta-analysis

“…Study participants in the intervention group received various physical therapy interventions modalities such as stretching, exercise therapy (posture, coordination, proprioception, strengthening underactive muscles, motor learning, relaxation, sensorimotor exercises with feedback), aquatic relaxation therapy, home exercise program, active and passive mobilizations of the neck, taping, biofeedback and Transcutaneous Electrical Neural Stimulation (TENS). Twelve out of 14 studies [ 24 – 28 , 30 , 31 , 33 – 37 ] applied various physical therapy modality interventions whereas 2 studies [ 29 , 32 ] used taping as the sole intervention.…”

“…The overall risk bias was found to be ‘low’ for almost all RCTs [ 24 , 26 , 27 , 29 , 31 , 32 ]; two RCTs [ 28 , 30 ] had ‘some concerns’ about their quality. The methodological qualities of all case-control studies [ 25 , 33 , 34 ] were found to be good.…”

“…The effect of PT on pain was investigated in all of the 14 studies [ 24 – 37 ]; four studies reported the VAS scale [ 28 , 29 , 35 , 36 ]; 10 studies [ 24 – 28 , 30 – 32 , 34 , 37 ] reported pain by the pain subscale of the TWSTRS; one study [ 33 ] reported both. All included studies reported a reduction of pain after physical therapy intervention which was 30% [ 28 , 36 ], 40% [ 34 ], and up to 50% [ 24 ] larger in the PT group compared to the control group.…”

“…The effect of PT on disease severity was investigated in 7 studies by the TWSTRS [ 25 , 26 , 28 , 30 – 32 , 34 ]. Van den Dool et al found an improvement of dystonic postures in the intervention group after they received specialized PT which emphasized motor training [ 31 ].…”

“…The effect of PT on disability was investigated in seven studies [ 25 , 26 , 28 , 30 – 32 , 34 ] by the TWSTRS and reported significant improvements. Tassorelli et al also reported a marked reduction in disability score by 4.5 in activities of daily living as compared to BoNT therapy alone [ 24 ].…”