Effect of the short and intensive rehabilitation (SHAiR) program on dynamic alignment in patients with dropped head syndrome during level walking

Inaugural dropped head syndrome and camptocormia in inflammatory myopathies: a retrospective study

OBJECTIVES

Inaugural axial muscle involvement, defined as dropped head syndrome (DHS) and/or camptocormia (CC), is poorly described in inflammatory myopathies (IM). This study aimed to further characterize IM patients with inaugural DHS/CC, their outcome and care management.

METHODS

This retrospective study included IM patients diagnosed between 2000 and 2021. The main inclusion criterion was IM revealed by axial muscle deficit (DHS/CC).

RESULTS

Twenty-seven patients were included; median (IQR) age at first symptoms was 66.0 years (55.5-75.0); 21 were female (77.8%). There were nine IBM, 33.3%, nine overlap myositis (OM, 33.3%), five DM, 18.5%, two immune checkpoint inhibitor-related myositis (7.4%), one focal myositis (3.7%) and one myositis with anti-Hu antibodies (3.7%). Age at first symptoms was ≤70 years in 16 patients (59.3%), including all DM patients and 8/9 OM patients (88.9%). In this group, partial remission of the disease was obtained in 9/16 (56.3%) and complete remission in 1/16 patients (6.3%); regression of DHS/CC was achieved in 3/16 patients (18.8%). Conversely, in the group of 11 patients aged >70 years at first symptoms, there were eight IBM (72.7%). Partial remission was obtained in 5/11 patients (45.5%), the disease was stable in 6/11 patients (54.5%); no complete remission was obtained nor regression of DHS/CC.

CONCLUSION

The analysis of IM patients with inaugural DHS/CC delineates two groups of patients according to the age at first symptoms in terms of clinical and outcome specificities, and proposes an adapted diagnostic and care management approach to prevent long-term complications.

Radiographic Outcomes of the Short and Intensive Rehabilitation (SHAiR) Program in Patients with Dropped Head Syndrome

Background

The radiographic outcomes of nonoperative treatment of dropped head syndrome are still unknown. The purpose of the present study was to assess the change in sagittal spinopelvic radiographic parameters after the short and intensive rehabilitation (SHAiR) program in patients with dropped head syndrome.

Methods

This study included 48 consecutive patients with dropped head syndrome who presented with an inability to maintain horizontal gaze and who underwent the SHAiR program during the period of 2018 to 2019. Patients were divided into 2 groups according to their ability to maintain horizontal gaze at the time of final follow-up: those who had regained horizontal gaze (the "effective" group) and those who had not regained horizontal gaze (the "noneffective" group). Sagittal radiographic parameters including the sagittal vertical axis (SVA), the C2-7 angle, the C2-7 SVA, T1 slope, thoracic kyphosis of T1-5 and T5-12, lumbar lordosis, pelvic tilt, pelvic incidence, sacral slope, and curve flexibility, and demographic data and clinical outcomes were compared between the 2 groups using an unpaired t test, chi-square test, and Fisher exact test, as appropriate.

Results

Thirty-five patients in the effective group and 13 patients in the noneffective group were analyzed. The rate of response in regaining horizontal gaze with the SHAiR program was 73%. The C2-7 angle, the C2-7 SVA, T1 slope, and thoracic kyphosis (T1-5) demonstrated significant correction in the effective group (p < 0.05). There were no significant changes in other parameters below the mid-thoracic spine-i.e., the thoracolumbar and lumbar spine and pelvis-following the SHAiR program. Scores of the Neck Disability Index and visual analog scale for pain improved significantly in both groups.

Conclusions

The SHAiR program improved horizontal gaze among a large percentage of our patients and reduced cervical pain among patients overall. The correction of thoracic kyphosis (T1-5) might be an important treatment target to restore the appropriate T1 tilt in patients with dropped head syndrome.

Level of Evidence

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Association between the Horizontal Gaze Ability and Physical Characteristics of Patients with Dropped Head Syndrome

Background and Objectives: Patients with dropped head syndrome exhibit weakness of the cervical paraspinal muscles. However, the relationship between horizontal gaze disorder and physical function remains unclear. This study aimed to examine and clarify this relationship. Materials and Methods: Ninety-six patients with dropped head syndrome were included. We measured the McGregor’s Slope and investigated physical characteristics, including cervical muscle strength, back muscle strength, and walking ability. Factor analysis was used to classify the characteristics of physical function, and a linear multiple regression analysis was used to evaluate independent variables explaining the variance in the McGregor’s Slope. The physical functions of DHS patients were classified into three categories by factor analysis: limb and trunk muscle strength, walking ability, and neck muscle strength. Results: The average value of the McGregor’s Slope was 22.2 ± 24.0 degrees. As a result of multiple regression analysis, walking speed (β = −0.46) and apex (β = −0.30) were extracted as significant factors influencing the McGregor’s Slope. Conclusions: Horizontal gaze disorders are not associated with cervical muscle strength but with the walking ability and the alignment type of dropped head syndrome.