Dystonia is a neurological disorder that affects millions of people in North America. It can cause a variety of symptoms, including involuntary muscle contractions, abnormal movements and postures, pain, fatigue, and stress. In this article, we will provide an overview of dystonia, including its causes and symptoms. We will also explore how physical therapy can help individuals with dystonia by improving movement and mobility, reducing pain, restoring function, and limiting disability.
What is Dystonia?
Dystonia is a movement disorder characterized by involuntary sustained or intermittent muscle contractions that can force the body into abnormal and sometimes painful movements and postures. The movements are twisting and often repetitive in nature and may affect a single muscle or a group of muscles, such as in the arm or leg. Voluntary movements often worsen the features of dystonia. There are approximately 13 forms of primary dystonia, and secondary dystonia caused by trauma or neurological conditions such as Parkinson's, Huntington's, and Multiple Sclerosis can lead to millions of people being affected by this condition.
Causes of Dystonia:
Dystonia can be caused by damage to multiple brain regions, including the basal ganglia, cerebellum, thalamus, brain stem, and parietal lobe. However, with idiopathic dystonia, there may be no evidence of damage with imaging. The theory behind this category of dystonia suggests that symptoms are caused by subtle abnormalities in inhibition pathways and sensory motor integration areas within the central nervous system.
In this presentation, dystonia is characterized by excessive co-contraction of agonist and antagonist muscles during the action, resulting in an overflow of muscle contractions and unwanted muscle spasms. This loss of motor inhibition has been found at the spinal, brain stem, and cortical levels.
Symptoms of Dystonia:
Due to the varying nature of dystonia, the early symptoms range widely depending on the location. With some, foot cramping can cause the foot to turn in or drag, handwriting can worsen with repetition, or muscles of the neck can cause the neck to turn or pull involuntarily. Some people experience repetitive eye blinking or trouble speaking due to the disease. Dystonia can progress through various stages. The initial symptoms can be mild and only occur with prolonged exertion, fatigue, or stress. The symptoms can then appear during functional everyday movements such as walking and can progress to appearing when a person is relaxed.
Medical management typically involves medications that affect the body's neurotransmitters (the chemical messengers that transmit messages between nerve cells). Botulinum toxin injections are a common treatment for focal dystonia treating specific muscle groups to help relieve symptoms by helping those muscles to relax.
Deep brain stimulation (DBS) may also be used in the management of dystonia, particularly when medications become ineffective. DBS involves surgically implanting small electrodes into brain areas that control movement and using controlled amounts of electricity to block the electric signals causing the symptoms
Physical Therapy & Exercise:
Physical Therapy plays a key role in managing dystonia through sensory-motor retraining and addressing the underlying deficits associated with dystonia. Dystonia can affect mobility, strength, balance, posture, and endurance. Physical therapy intervention can help clients with dystonia by improving movement and mobility, decreasing pain, restoring function, and limiting disability.
Physical therapy can help by improving awareness of body posture and body movement through various techniques such as facilitation, taping, and biofeedback, increasing the range of motion of shortened muscles and strengthening underutilized muscles to improve the efficiency of movement, providing balance assessment and training to improve mobility and balance reactions, and to minimize falls, assessing and prescribing braces, orthotics, and other equipment to promote independence, enhancing the effects.
How Can We Help You?
If you are experiencing the symptoms of dystonia, it is important to seek out professional help to manage your condition.
Our experienced clinicians use a variety of techniques to improve your movement, mobility, and balance, and decrease pain and other symptoms associated with dystonia. We work closely with you to develop a personalized treatment plan that addresses your unique needs and goals.
Our physical therapy program for dystonia is based on Learning-based Sensorimotor Training (Adapted from Byl, Archer, McKenzie, 2008). These are three distinct components of this program:
Prepare the brain by incorporating a healthy lifestyle routine, mindfulness practice, and engaging mental imagery of performing the task normally - "Recapturing the joy of performing movement"
Re-train the brain comprising sensory-motor re-education to improve body awareness and movement control along with graded exposure to movement with increasing variability.
Treat Underlying Factors:
focusing on improving range of motion, strength, balance, and posture.
Contact us today to learn more about how we can help you manage your dystonia and achieve your goals.
Albanese A, Bhatia K, Bressman SB, et al. Phenomenology and classification of dystonia: a consensus update. Mov Disord. 2013;28(7):863-873. doi:10.1002/mds.25475
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(2):183-198. Doi: 10.1016/j.jht.2008.12.003
Phukan J, Albanese A, Gasser T, Warner T. Primary dystonia, and dystonia-plus syndromes: clinical characteristics, diagnosis, and pathogenesis. Lancet Neurol. 2011;10(12):1074-1085. doi:10.1016/S1474-4422(11)70232-0